Basic Information
| Provider Information | |||||||||
| NPI: | 1689691321 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIO-MEDICAL APPLICATIONS OF NORTH CAROLINA, INC. | ||||||||
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| OtherOrganizationName: | BMA CONCORD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 BRANCHVIEW DR SE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280253578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047824152 | ||||||||
| FaxNumber: | 7047829451 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 BRANCHVIEW DR SE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280253578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047824152 | ||||||||
| FaxNumber: | 7047829451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FAWCETT | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 8006621237 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 3412519 | 05 | NC | MEDICAID |