Healthcare Provider Details

I. General information

NPI: 1912019761
Provider Name (Legal Business Name): BIO-MEDICAL APPLICATIONS OF LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 COMMERCIAL DR
PORT ALLEN LA
70767-6145
US

IV. Provider business mailing address

2500 COMMERCIAL DR
PORT ALLEN LA
70767-6145
US

V. Phone/Fax

Practice location:
  • Phone: 225-343-5753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK FAWCETT
Title or Position: TREASURER
Credential:
Phone: 781-402-9000