Provider Demographics
NPI:1669626750
Name:BIOMODAL LLC
Entity Type:Organization
Organization Name:BIOMODAL LLC
Other - Org Name:BIOMODAL ANAPLASTOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:STEVENSON
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:919-906-0287
Mailing Address - Street 1:718 DELANY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1614
Mailing Address - Country:US
Mailing Address - Phone:919-906-0287
Mailing Address - Fax:919-833-5674
Practice Address - Street 1:1233 FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7534
Practice Address - Country:US
Practice Address - Phone:919-906-0287
Practice Address - Fax:919-833-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCN/A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies