Healthcare Provider Details

I. General information

NPI: 1497633127
Provider Name (Legal Business Name): MICHAEL BRISCOE CPRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 1/2 E MAIN ST
LANCASTER OH
43130-3809
US

IV. Provider business mailing address

PO BOX 602
LANCASTER OH
43130-0602
US

V. Phone/Fax

Practice location:
  • Phone: 614-404-6008
  • Fax:
Mailing address:
  • Phone: 614-506-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006765
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: