MEDICARE: BMDMOBILE

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	2471B0102X	Bone Densitometry Radiologic Technologist	00026813	AL

General Provider Information

NPI Number	:	1750388278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BMDMOBILE

Provider Business Mailing Address
First Line	:	3109 GRAND AVE
Second Line	:	#437
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-5103
Country	:	US
Telephone Number	:	305-332-6151
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 GRAND AVE
Second Line	:	#437
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-5103
Country	:	US
Telephone Number	:	305-332-6151
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER HANCOCK
Credential	:	M.D.
Telephone Number	:	305-332-6151

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	08/22/2020

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Directions to “BMDMOBILE ” Practice Location

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