1396979407 NPI number — BRAVIS ENTERPRISES, INC.

Table of content: (NPI 1396979407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396979407 NPI number — BRAVIS ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAVIS ENTERPRISES, INC.
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:
6
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:
1396979407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 RENAISSANCE DRIVE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16001-7612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-282-0755
Provider Business Mailing Address Fax Number:
724-282-7723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1008 SOUTH 5TH AVE.
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CLARION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16214-8676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-282-0755
Provider Business Practice Location Address Fax Number:
724-282-0755
Provider Enumeration Date:
05/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
KELLI
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
724-282-0755

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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