1598968604 NPI number — BETH ANN BRYANT M.D. PSC

Table of content: (NPI 1598968604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598968604 NPI number — BETH ANN BRYANT M.D. PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETH ANN BRYANT M.D. PSC
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:
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:
1598968604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1325 ANDREA ST
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42104-5852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-842-7272
Provider Business Mailing Address Fax Number:
270-842-7478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 ANDREA ST
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42104-5852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-842-7272
Provider Business Practice Location Address Fax Number:
270-842-7478
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRYANT
Authorized Official First Name:
BETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
270-842-7272

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  327783 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64327836 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com