Healthcare Provider Details

I. General information

NPI: 1548599301
Provider Name (Legal Business Name): BIO-MEDICAL APPLICATIONS OF NEW MEXICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE SUITE 100
ALBUQUERQUE NM
87108-4729
US

IV. Provider business mailing address

5400 GIBSON BLVD SE SUITE 100
ALBUQUERQUE NM
87108-4729
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 Number
License Number State

VIII. Authorized Official

Name: MARK R. FAWCETT
Title or Position: TREASURER
Credential:
Phone: 781-699-9000