Basic Information
| Provider Information | |||||||||
| NPI: | 1558851170 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BGM, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045211576 | ||||||||
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| Practice Location | |||||||||
| Address1: | 141 EULA GRAY ST | ||||||||
| Address2: | |||||||||
| City: | HARLAN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 408311778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023708424 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2018 | ||||||||
| LastUpdateDate: | 05/18/2018 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5023708424 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
No ID Information.