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General NPI Number Information
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NPI Number | 1841038544
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Entity Type | Organization
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Legal Business Name | BM WELLNESS CENTER LLC
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Dates
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Enumeration Date | 07/17/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 10709 SW 240TH TER
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City | HOMESTEAD
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State | FL
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Zip | 33032-5182
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Country | US
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Telephone | 786-309-0168
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Fax |
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Provider Business Mailing Address
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Address Line | 10709 SW 240TH TER
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City | HOMESTEAD
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State | FL
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Zip | 33032-5182
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Country | US
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Telephone | 786-309-0168
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRYAN MADRUGA
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Credential | GROUP
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Telephone | 786-309-0168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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