1760479745 NPI number — W L BROWN MEDICAL CORPORATION

Table of content: (NPI 1760479745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760479745 NPI number — W L BROWN MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
W L BROWN MEDICAL CORPORATION
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:
1760479745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 E SPRUCE AVE
Provider Second Line Business Mailing Address:
C
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-3374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-265-4444
Provider Business Mailing Address Fax Number:
559-265-4454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 E SPRUCE AVE
Provider Second Line Business Practice Location Address:
C
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-3374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-265-4444
Provider Business Practice Location Address Fax Number:
559-265-4454
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
WILLIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
559-265-4444

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1043300874 . This is a "DR. BROWN JR NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1002 . This is a "CERT NURSE MIDWIFE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1225063969 . This is a "ANNE WILKES NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A40710 . This is a "CALIFORNIA MEDICAL LICENS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GROO29520 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAB73144F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com