MEDICARE: MR. BRANDON HEATH AMSLER GENERAL CONTRACTOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor	2705156240	VA

General Provider Information

NPI Number	:	1952870958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRANDON HEATH AMSLER GENERAL CONTRACTOR

Provider Business Mailing Address
First Line	:	400 SOUTHLAKE BLVD STE E2
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-3061
Country	:	US
Telephone Number	:	804-929-2656
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 SOUTHLAKE BLVD STE E2
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-3061
Country	:	US
Telephone Number	:	804-929-2656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	11/19/2018

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