1033210612 NPI number — BREWER MEDICAL SERVICES, INC.

Table of content: (NPI 1033210612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033210612 NPI number — BREWER MEDICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREWER MEDICAL SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033210612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2724 N JACKSON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHEFFIELD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35660-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-389-9393
Provider Business Mailing Address Fax Number:
256-383-1870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 E GAINES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38464-3342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-389-9393
Provider Business Practice Location Address Fax Number:
256-383-1870
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BREWER
Authorized Official First Name:
KELVIN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
256-389-9393

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000000857 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING . This is a "DMERC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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