| NPI |
1346344116 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
| Provider Organization Name Legal Business Name |
BIO-MEDICAL APPLICATIONS OF VIRGINIA, INC. |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Provider Other Organization Name |
MOUNTAIN EMPIRE DIALYSIS CENTER |
Other name by which the organization provider is or has been known. |
| Provider Other Organization Name Type Code |
3 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider First Line Business Practice Location Address |
340 ANDERSON HOLLOW RD STE 100 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider Business Practice Location Address City Name |
NORTON |
|
| Provider Business Practice Location Address State Name |
VA |
|
| Provider Business Practice Location Address Postal Code |
242731100 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider Business Practice Location Address Telephone Number |
2766797805 |
|
| Provider Business Practice Location Address Fax Number |
2766797812 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Provider Enumeration Date |
9/12/2006 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Last Update Date |
10/13/2023 |
The date that a record was last updated or changed. |
| Authorized Official Last Name |
BLANTON |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Authorized Official First Name |
BARRY |
The first name of the authorized official. |
| Authorized Official Middle Name |
L. |
The middle name of the authorized official. |
| Authorized Official Title or Position |
VICE PRESIDENT |
The title or position of the authorized official. |
| Authorized Official Telephone Number |
7816999000 |
The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 |
261QE0700X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Is Organization Subpart |
Y |
|
| Parent Organization LBN |
FRESENIUS MEDICAL CARE HOLDINGS, INC. |
|
| Parent Organization TIN |
|
|
| NPI Certification Date |
10/13/2023 |
|