Healthcare Provider Details

I. General information

NPI: 1134111594
Provider Name (Legal Business Name): BRINKS FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N MAIN ST
PRINCETON IN
47670-1516
US

IV. Provider business mailing address

410 N MAIN ST
PRINCETON IN
47670-1516
US

V. Phone/Fax

Practice location:
  • Phone: 812-386-7522
  • Fax: 812-386-1097
Mailing address:
  • Phone: 812-386-7522
  • Fax: 812-386-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50003963A
License Number StateIN

VIII. Authorized Official

Name: BRUCE CARLTON BRINK
Title or Position: PRESIDENT OF THE CORP
Credential: DO
Phone: 812-386-7522