MEDICARE: BMSC HMO LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	103TC0700X	Clinical Psychologist
4	106H00000X	Marriage & Family Therapist
5	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1396545067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BMSC HMO LLC

Provider Business Mailing 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	:	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	:	954-324-8354

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MELANIE DONOHUE
Credential	:	LCSW
Telephone Number	:	702-403-0438

Provider Enumeration Date	:	03/13/2025
Last Update Date	:	03/13/2025

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