1740371749 NPI number — THOMAS F BRILL OD

Table of content: THOMAS F BRILL OD (NPI 1740371749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740371749 NPI number — THOMAS F BRILL OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRILL
Provider First Name:
THOMAS
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1740371749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 E VENICE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34285-9066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-488-2020
Provider Business Mailing Address Fax Number:
941-484-2200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14844 TAMIAMI TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34287-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-484-2020
Provider Business Practice Location Address Fax Number:
941-426-8701
Provider Enumeration Date:
09/27/2006

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: 152W00000X , with the licence number:  OPC1260 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 62009820 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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