| Bhg Lxxiii, Llc | |
|
1714 Platt Place Montgomery AL 36117 | |
| (334) 245-7680 | |
| Not Available |
| Full Name | Bhg Lxxiii, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1714 Platt Place, Montgomery, Alabama |
| Authorized Official Name and Position | Jemece Gasaway (DIRECTOR OF LICENSING) |
| Authorized Official Contact | 2143656126 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bhg Lxxiii, Llc 5001 Spring Valley Road Suite 600 East Dallas TX 75244 Ph: (214) 365-6100 | Bhg Lxxiii, Llc 1714 Platt Place Montgomery AL 36117 Ph: (334) 245-7680 |
| NPI Number | 1568061307 |
|---|---|
| Provider Enumeration Date | 10/22/2020 |
| Last Update Date | 10/22/2020 |
| Certification Date | 10/22/2020 |
| Medicare PECOS PAC ID | 9335552298 |
|---|---|
| Medicare Enrollment ID | O20210113002937 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568061307 | NPI | - | NPPES |
| Provider Name | Gary E Holland |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962457077 PECOS PAC ID: 8325935406 Enrollment ID: I20060209000033 |
| Provider Name | Andrea L Hall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144437492 PECOS PAC ID: 4880758903 Enrollment ID: I20120123000310 |
| Provider Name | Roy Barco |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033436191 PECOS PAC ID: 7517108871 Enrollment ID: I20130729000802 |
| Provider Name | Amy M Gorecki-kelley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639651300 PECOS PAC ID: 8921345034 Enrollment ID: I20190128003193 |
| Provider Name | Lucas Scott Boone |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134651102 PECOS PAC ID: 3173881364 Enrollment ID: I20200326002478 |
| Provider Name | Brian V Hopkins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992248355 PECOS PAC ID: 8224441506 Enrollment ID: I20210105002042 |
| Provider Name | Bianca Crenshaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235841198 PECOS PAC ID: 3476917121 Enrollment ID: I20230913002375 |
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