1366557191 NPI number — BIO-MEDICAL APPLICATIONS OF MICHIGAN, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366557191 NPI number — BIO-MEDICAL APPLICATIONS OF MICHIGAN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIO-MEDICAL APPLICATIONS OF MICHIGAN, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OWOSSO MEMORIAL DIALYSIS CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366557191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 HEALTH PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWOSSO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48867-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-725-1041
Provider Business Mailing Address Fax Number:
989-725-1061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 HEALTH PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWOSSO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48867-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-725-1041
Provider Business Practice Location Address Fax Number:
989-725-1061
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLANTON
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
214-445-3010

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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