1154328060 NPI number — DR. COLLEEN Q BRATSCH D.O. F.A.C.O.G.

Table of content: DR. COLLEEN Q BRATSCH D.O. F.A.C.O.G. (NPI 1154328060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154328060 NPI number — DR. COLLEEN Q BRATSCH D.O. F.A.C.O.G.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRATSCH
Provider First Name:
COLLEEN
Provider Middle Name:
Q
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O. F.A.C.O.G.
Provider Gender Code:
F

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:
1154328060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1272 GARRISON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37129-2598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-867-8030
Provider Business Mailing Address Fax Number:
615-867-8195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1272 GARRISON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37129-2598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-867-8030
Provider Business Practice Location Address Fax Number:
615-848-1182
Provider Enumeration Date:
07/07/2005

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: 174400000X , with the licence number:  DO0000001574 , 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: 33080301 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1510801 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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