| Bhg Xlv, Llc | |
|
2402 Tift Ave N Suite 202 Tifton GA 31794-1883 | |
| (757) 962-0748 | |
| Not Available |
| Full Name | Bhg Xlv, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2402 Tift Ave N, Tifton, Georgia |
| Authorized Official Name and Position | Jemece Michelle 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 Xlv, Llc 5001 Spring Valley Rd Suite 600 East Dallas TX 75244-3946 Ph: (214) 365-6100 | Bhg Xlv, Llc 2402 Tift Ave N Suite 202 Tifton GA 31794-1883 Ph: (757) 962-0748 |
| NPI Number | 1992241400 |
|---|---|
| Provider Enumeration Date | 01/09/2017 |
| Last Update Date | 02/20/2019 |
| Medicare PECOS PAC ID | 9032544663 |
|---|---|
| Medicare Enrollment ID | O20200108002706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992241400 | NPI | - | NPPES |
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