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General NPI Number Information
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NPI Number | 1558483776
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Entity Type | Organization
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Legal Business Name | BMB ASSOCIATES LLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 2698 N GALLOWAY AVE
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City | MESQUITE
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State | TX
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Zip | 75150-6383
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Country | US
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Telephone | 972-681-4000
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Fax | 972-681-0881
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Provider Business Mailing Address
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Address Line | 2698 N GALLOWAY AVE
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City | MESQUITE
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State | TX
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Zip | 75150-6383
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Country | US
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Telephone | 972-681-4000
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Fax | 972-681-0881
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MINU MAMMEN MATHEW
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Credential | R, MR, ARRT
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Telephone | 972-681-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | R31261
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | R31261
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | R31261
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License Number State | TX
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