Provider Demographics
NPI:1588110282
Name:DR BAH, LLC
Entity type:Organization
Organization Name:DR BAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HEISKELL
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:956-230-1851
Mailing Address - Street 1:PO BOX 532620
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-2620
Mailing Address - Country:US
Mailing Address - Phone:956-230-1851
Mailing Address - Fax:956-365-3557
Practice Address - Street 1:1125 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7706
Practice Address - Country:US
Practice Address - Phone:956-230-1851
Practice Address - Fax:956-365-3557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROCARE NEURO-MONITORING SERVICES OF TEXAS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Multi-Specialty