Healthcare Provider Details

I. General information

NPI: 1710587571
Provider Name (Legal Business Name): BMH KIDNEY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S 200 W STE B
BLANDING UT
84511-3910
US

IV. Provider business mailing address

802 S 200 W STE B
BLANDING UT
84511-3910
US

V. Phone/Fax

Practice location:
  • Phone: 435-678-3993
  • Fax:
Mailing address:
  • Phone: 435-678-3993
  • 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: JEREMY LYMAN
Title or Position: DIRECTOR
Credential:
Phone: 435-678-3993