| NPI | 1881119618 |
|---|---|
| Doing Business As | BAGWELL MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | MICHAEL BRIAN BAGWELL Sole Member 662-422-1798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2017-08-14 |