Provider Demographics
NPI:1184250573
Name:BIOMATRIX LLC
Entity type:Organization
Organization Name:BIOMATRIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-707-3088
Mailing Address - Street 1:9220 S TOLEDO CT STE B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2745
Mailing Address - Country:US
Mailing Address - Phone:918-707-3088
Mailing Address - Fax:
Practice Address - Street 1:9220 S TOLEDO CT STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2745
Practice Address - Country:US
Practice Address - Phone:918-707-3088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty