MEDICARE: BHM MEDICAL FACILITIES, 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	314000000X	Skilled Nursing Facility	031109	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	198617	OTHER	MO	BLUECROSS AND BLUE SHIELD
3	031109	OTHER	MO	FACILITY LICENSE NUMBER

General Provider Information

NPI Number	:	1578560462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHM MEDICAL FACILITIES, LLC

Provider Business Mailing Address
First Line	:	705 GRAND CANYON DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-2161
Country	:	US
Telephone Number	:	573-756-8911
Fax Number	:	573-756-0862

Provider Business Practice Location Address
First Line	:	705 GRAND CANYON DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-2161
Country	:	US
Telephone Number	:	573-756-8911
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RONALD GENE ROBINSON
Credential	:
Telephone Number	:	573-756-8911

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/24/2015

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