MEDICARE: BIO-MEDICAL APPLICATIONS OF SOUTH FLORIDA, INC., DBA BMA KEY WEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	102543	FL

General Provider Information

NPI Number	:	1497839385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIO-MEDICAL APPLICATIONS OF SOUTH FLORIDA, INC., DBA BMA KEY WEST

Provider Business Mailing Address
First Line	:	1122 NORTH. ROOSEVELT BLVD
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040
Country	:	US
Telephone Number	:	305-294-8453
Fax Number	:	305-294-3421

Provider Business Practice Location Address
First Line	:	1122 NORTH ROOSEVELT BOULEVARD
Second Line	:	KEY PLAZA
City	:	KEY WEST
State	:	FL
Zip	:	33040
Country	:	US
Telephone Number	:	305-294-8453
Fax Number	:	305-294-3421

Authorized Official
Title or Position	:	CEO
Name	:	MR. MATS WAHLSTROM
Credential	:
Telephone Number	:	800-662-1237

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/22/2020

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