Organization
BCS ABUNDANT LIFE FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL BRYAN BACAK M.D. (PRESIDENT)
(979) 695-3570
Entity
Organization
Contact information
Practice address
2911 TEXAS AVE S STE 202, COLLEGE STATION, TX 77845-5388
(979) 695-3570
Mailing address
2911 TEXAS AVE S STE 202, COLLEGE STATION, TX 77845-5388
(979) 695-3570
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
K5445
TX
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0061LC
BLUE CROSS NUMBER
TX
05
—
165201801
—
TX
01
—
DB9563
MEDICARE RAILROAD
TX
Enumeration date
10/18/2006
Last updated
01/14/2026
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