MEDICARE: BIO-MEDICAL APPLICATIONS OF WEST VIRGINIA, INC.

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1629517743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIO-MEDICAL APPLICATIONS OF WEST VIRGINIA, INC.

Provider Business Mailing Address
First Line	:	4 NORTHRIDGE DR STE 116
Second Line	:
City	:	BUCKHANNON
State	:	WV
Zip	:	26201-8484
Country	:	US
Telephone Number	:	304-472-9167
Fax Number	:	304-472-6234

Provider Business Practice Location Address
First Line	:	4 NORTHRIDGE DR STE 116
Second Line	:
City	:	BUCKHANNON
State	:	WV
Zip	:	26201-8484
Country	:	US
Telephone Number	:	304-472-9167
Fax Number	:	304-472-6234

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BARRY L. BLANTON
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	02/22/2017
Last Update Date	:	10/20/2023

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