Basic Information
| Provider Information | |||||||||
| NPI: | 1821232406 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRMS OB/GYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 INTERSTATE PKWY | ||||||||
| Address2: | |||||||||
| City: | BRADFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167011036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143683123 | ||||||||
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| Practice Location | |||||||||
| Address1: | 159 INTERSTATE PKWY | ||||||||
| Address2: | |||||||||
| City: | BRADFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167011013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143683123 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2009 | ||||||||
| LastUpdateDate: | 12/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | CHILSON | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PRACTICE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 8143628277 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BRADFORD REGIONAL MEDICAL SERVICES | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD024058E | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.