Provider Demographics
NPI:1114627361
Name:BLS DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:BLS DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-526-8088
Mailing Address - Street 1:1728 SHAKESPEARE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1558
Mailing Address - Country:US
Mailing Address - Phone:866-526-8088
Mailing Address - Fax:
Practice Address - Street 1:11623 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-1310
Practice Address - Country:US
Practice Address - Phone:443-483-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD193200000XMedicaid