1669688909 NPI number — JIMMY C. BRASFIELD, PC

Table of content: (NPI 1669688909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669688909 NPI number — JIMMY C. BRASFIELD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JIMMY C. BRASFIELD, PC
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:
BRISTOL NEUROSURGICAL ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1669688909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17016
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24209-7016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-844-6407
Provider Business Mailing Address Fax Number:
866-769-7784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 BRISTOL WEST BLVD
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37620-8765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-844-6407
Provider Business Practice Location Address Fax Number:
888-769-7784
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRASFIELD
Authorized Official First Name:
JIMMY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
423-844-6407

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com