MEDICARE: BMSC NV LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW8327	FL

General Provider Information

NPI Number	:	1245648419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BMSC NV LLC

Provider Business Mailing Address
First Line	:	10204 BODE ST STE B
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60585-9813
Country	:	US
Telephone Number	:	855-241-7160
Fax Number	:	954-324-8354

Provider Business Practice Location Address
First Line	:	4575 DEAN MARTIN DR UNIT 1200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-8205
Country	:	US
Telephone Number	:	702-403-0438
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MELANIE ELIZABETH DONOHUE
Credential	:	LCSW
Telephone Number	:	855-241-7160

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	05/18/2021

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Directions to “BMSC NV LLC ” Practice Location

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