1447239389 NPI number — WILLIAM J BRANNICK MD

Table of content: WILLIAM J BRANNICK MD (NPI 1447239389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447239389 NPI number — WILLIAM J BRANNICK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANNICK
Provider First Name:
WILLIAM
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1447239389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2006 FRANKLIN ST SE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-4537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-539-0457
Provider Business Mailing Address Fax Number:
256-539-5827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2006 FRANKLIN ST SE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-4551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-539-0457
Provider Business Practice Location Address Fax Number:
256-539-5827
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  ME124304 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD34142 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 34928 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 183331 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184445 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 265947 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: I50MM . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 183164 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 183230 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213891 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300131093 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4042333 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: IG582X . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 266064 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015118000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 239945 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3870864 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000269739 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 266065 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: IG582Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 183226 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 183315 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 183318 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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