1649357781 NPI number — BRYAN AND SANG MEDICAL ASSOCIATES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649357781 NPI number — BRYAN AND SANG MEDICAL ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRYAN AND SANG MEDICAL ASSOCIATES, 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:
1649357781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29802-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-648-0874
Provider Business Mailing Address Fax Number:
803-648-5665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10187 DUNBARTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNWELL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29812-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-259-5391
Provider Business Practice Location Address Fax Number:
803-259-0472
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRYAN
Authorized Official First Name:
GASNEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
803-648-0874

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  12145 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP3802 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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