Provider Demographics
NPI:1689691321
Name:BIO-MEDICAL APPLICATIONS OF NORTH CAROLINA, INC.
Entity Type:Organization
Organization Name:BIO-MEDICAL APPLICATIONS OF NORTH CAROLINA, INC.
Other - Org Name:BMA CONCORD
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:800-662-1237
Mailing Address - Street 1:217 BRANCHVIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3578
Mailing Address - Country:US
Mailing Address - Phone:704-782-4152
Mailing Address - Fax:704-782-9451
Practice Address - Street 1:217 BRANCHVIEW DR SE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3578
Practice Address - Country:US
Practice Address - Phone:704-782-4152
Practice Address - Fax:704-782-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3412519Medicaid
NC3412519Medicaid