Provider Demographics
NPI:1083185748
Name:BIOMEDRX INC.
Entity type:Organization
Organization Name:BIOMEDRX INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LOCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:BMET, CE, CNT, CBPT
Authorized Official - Phone:424-204-2382
Mailing Address - Street 1:8306 WILSHIRE BLVD STE 777
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2304
Mailing Address - Country:US
Mailing Address - Phone:142-420-4238
Mailing Address - Fax:
Practice Address - Street 1:916 N MOUNTAIN AVE STE D1
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3658
Practice Address - Country:US
Practice Address - Phone:909-608-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:060893273
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-06
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health