Provider Demographics
NPI:1568444206
Name:BIO MEDICAL GROUP
Entity Type:Organization
Organization Name:BIO MEDICAL GROUP
Other - Org Name:RELIANCE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-457-9911
Mailing Address - Street 1:3337 E LOOP 820 S
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-1816
Mailing Address - Country:US
Mailing Address - Phone:817-457-9911
Mailing Address - Fax:817-457-3866
Practice Address - Street 1:3337 E LOOP 820 S
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-1816
Practice Address - Country:US
Practice Address - Phone:817-457-9911
Practice Address - Fax:817-457-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0083549332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5530080001Medicare NSC