Provider Demographics
NPI:1558473389
Name:BIO-MEDICAL APPLICATIONS OF SOUTH CAROLINA, INC.
Entity Type:Organization
Organization Name:BIO-MEDICAL APPLICATIONS OF SOUTH CAROLINA, INC.
Other - Org Name:CHESTERFIELD COUNTY DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-402-9000
Mailing Address - Street 1:206 ZOAR RD
Mailing Address - Street 2:ROUTE 1, BOX 428
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-5147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 ZOAR RD
Practice Address - Street 2:ROUTE 1, BOX 428
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-5147
Practice Address - Country:US
Practice Address - Phone:843-623-3677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
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
422551Medicare ID - Type Unspecified