Provider Demographics
NPI:1497839385
Name:BIO-MEDICAL APPLICATIONS OF SOUTH FLORIDA, INC., DBA BMA KEY WEST
Entity Type:Organization
Organization Name:BIO-MEDICAL APPLICATIONS OF SOUTH FLORIDA, INC., DBA BMA KEY WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATS
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-662-1237
Mailing Address - Street 1:1122 NORTH. ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040
Mailing Address - Country:US
Mailing Address - Phone:305-294-8453
Mailing Address - Fax:305-294-3421
Practice Address - Street 1:1122 NORTH ROOSEVELT BOULEVARD
Practice Address - Street 2:KEY PLAZA
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040
Practice Address - Country:US
Practice Address - Phone:305-294-8453
Practice Address - Fax:305-294-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL102543261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment