1366492027 NPI number — AMY G BRENNER MD

Table of content: AMY G BRENNER MD (NPI 1366492027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366492027 NPI number — AMY G BRENNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENNER
Provider First Name:
AMY
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1366492027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 78
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47701-0078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-467-2392
Provider Business Mailing Address Fax Number:
812-471-6650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7593 TYLERS PLACE BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45069-6312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-777-0787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2006

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: 207V00000X , with the licence number:  35078006 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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