Provider Demographics
NPI:1285935825
Name:BM&PROFESSIONAL ASSOCIATE,INC
Entity type:Organization
Organization Name:BM&PROFESSIONAL ASSOCIATE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:786-662-9188
Mailing Address - Street 1:3140 NW 53RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-3472
Mailing Address - Country:US
Mailing Address - Phone:786-662-9188
Mailing Address - Fax:786-431-5734
Practice Address - Street 1:3140 NW 53RD LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-3472
Practice Address - Country:US
Practice Address - Phone:786-662-9188
Practice Address - Fax:786-431-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13096302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization