Provider Demographics
NPI:1750493581
Name:BIO-MEDICAL APPLICATIONS OF FAYETTEVILLE, INC.
Entity Type:Organization
Organization Name:BIO-MEDICAL APPLICATIONS OF FAYETTEVILLE, INC.
Other - Org Name:FAYETTEVILLE KIDNEY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:2560 LEGION RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-4054
Mailing Address - Country:US
Mailing Address - Phone:910-426-2001
Mailing Address - Fax:910-426-1142
Practice Address - Street 1:2560 LEGION RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-4054
Practice Address - Country:US
Practice Address - Phone:910-426-2001
Practice Address - Fax:910-426-1142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2023-10-13
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
342510Medicare Oscar/Certification