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General NPI Number Information
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NPI Number | 1568444206
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Entity Type | Organization
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Legal Business Name | BIO MEDICAL GROUP
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3337 E LOOP 820 S
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City | FORT WORTH
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State | TX
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Zip | 76119-1816
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Country | US
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Telephone | 817-457-9911
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Fax | 817-457-3866
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Provider Business Mailing Address
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Address Line | 3337 E LOOP 820 S
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City | FORT WORTH
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State | TX
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Zip | 76119-1816
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Country | US
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Telephone | 817-457-9911
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Fax | 817-457-3866
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES BRETT BLEVINS
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Credential |
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Telephone | 817-457-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0083549
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License Number State | TX
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