Basic Information
| Provider Information | |||||||||
| NPI: | 1659893337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BILBRO | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424311658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703263900 | ||||||||
| FaxNumber: | 2703263905 | ||||||||
| Practice Location | |||||||||
| Address1: | 1851 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424319024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708257268 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2017 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04605 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100508650 | 05 | KY | MEDICAID |