Provider Demographics
NPI:1356453112
Name:BIO-MEDICAL APPLICATIONS OF MISSISSIPPI, INC.
Entity Type:Organization
Organization Name:BIO-MEDICAL APPLICATIONS OF MISSISSIPPI, INC.
Other - Org Name:SOUTH MISSISSIPPI KIDNEY CENTER (SMKC) - ORANGE GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:11531 OLD HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2654
Mailing Address - Country:US
Mailing Address - Phone:228-832-9293
Mailing Address - Fax:228-832-9586
Practice Address - Street 1:11531 OLD HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2654
Practice Address - Country:US
Practice Address - Phone:228-832-9293
Practice Address - Fax:228-832-9586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
252547Medicare ID - Type Unspecified