MEDICARE: BIO-MEDICAL APPLICATIONS OF LOUISIANA, LLC

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

General Provider Information

NPI Number	:	1821232729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIO-MEDICAL APPLICATIONS OF LOUISIANA, LLC

Provider Business Mailing Address
First Line	:	4848 MANCUSO LANE
Second Line	:	SUITE B
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3516
Country	:	US
Telephone Number	:	225-767-7844
Fax Number	:	225-767-7885

Provider Business Practice Location Address
First Line	:	4848 MANCUSO LANE
Second Line	:	SUITE B
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3516
Country	:	US
Telephone Number	:	225-767-7844
Fax Number	:	225-767-7885

Authorized Official
Title or Position	:	TREASURER
Name	:	MARK FAWCETT
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2009

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