Provider Demographics
NPI:1619915204
Name:BIO-MEDICAL APPLICATIONS OF TEXAS, INC.
Entity Type:Organization
Organization Name:BIO-MEDICAL APPLICATIONS OF TEXAS, INC.
Other - Org Name:CARRIZO SPRINGS KIDNEY DISEASE CLINIC
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 1:409 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-3805
Mailing Address - Country:US
Mailing Address - Phone:830-876-3939
Mailing Address - Fax:830-876-3901
Practice Address - Street 1:409 S 7TH ST
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834-3805
Practice Address - Country:US
Practice Address - Phone:830-876-3939
Practice Address - Fax:830-876-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
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
TXZ07984428Medicaid
TXZ07984428Medicaid