MEDICARE: BIO MEDICAL GROUP

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	332BX2000X	Oxygen Equipment & Supplies (DME)	0083549	TX

General Provider Information

NPI Number	:	1568444206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIO MEDICAL GROUP

Provider Business Mailing Address
First Line	:	3337 E LOOP 820 S
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-1816
Country	:	US
Telephone Number	:	817-457-9911
Fax Number	:	817-457-3866

Provider Business Practice Location Address
First Line	:	3337 E LOOP 820 S
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-1816
Country	:	US
Telephone Number	:	817-457-9911
Fax Number	:	817-457-3866

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLES BRETT BLEVINS
Credential	:
Telephone Number	:	817-457-9911

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	08/22/2020

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