Healthcare Provider Details

I. General information

NPI: 1164629358
Provider Name (Legal Business Name): BIO-MEDICAL APPLICATIONS OF NEW MEXICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87110-3948
US

IV. Provider business mailing address

5031 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87110-3948
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-0111
  • Fax: 505-255-4101
Mailing address:
  • Phone: 505-255-0111
  • Fax: 505-255-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number6122
License Number StateNM

VIII. Authorized Official

Name: BARRY L. BLANTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 781-699-9000