1831361641 NPI number — BRAUNLICH ORTHOPEDICS, LLC

Table of content: (NPI 1831361641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831361641 NPI number — BRAUNLICH ORTHOPEDICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAUNLICH ORTHOPEDICS, LLC
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:
1831361641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 EOFF STREET
Provider Second Line Business Mailing Address:
SUITE 604
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-6391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-312-2216
Provider Business Mailing Address Fax Number:
304-231-3850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 EOFF STREET
Provider Second Line Business Practice Location Address:
SUITE 604
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-6391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-312-2216
Provider Business Practice Location Address Fax Number:
304-231-3850
Provider Enumeration Date:
04/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRAUNLICH
Authorized Official First Name:
EARL
Authorized Official Middle Name:
FRITZ
Authorized Official Title or Position:
PHYSICIAN/PRESIDENT
Authorized Official Telephone Number:
304-242-9460

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  22872 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2946049 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11832445 . This is a "CAQH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810012425 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205811130 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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