Healthcare Provider Details

I. General information

NPI: 1235184748
Provider Name (Legal Business Name): BIO-MEDICAL APPLICATIONS OF PENNSYLVANIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ARENTZEN BLVD STE 105 VISTA 1 PROFESSIONAL CTR - CKD SERVICES
CHARLEROI PA
15022-1085
US

IV. Provider business mailing address

920 WINTER ST FMCNA CKD SERVICES
WALTHAM MA
02451-1521
US

V. Phone/Fax

Practice location:
  • Phone: 724-489-0850
  • Fax: 724-489-0854
Mailing address:
  • Phone: 781-699-4160
  • Fax: 781-699-4046

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 StatePA

VIII. Authorized Official

Name: MR. MARK FAWCETT
Title or Position: TREASURER
Credential:
Phone: 781-699-2668