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General NPI Number Information
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NPI Number | 1104154236
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Entity Type | Organization
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Legal Business Name | BRD MANAGEMENT
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Dates
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Enumeration Date | 12/01/2009
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 3802 OLENTANGY RIVER RD
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City | COLUMBUS
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State | OH
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Zip | 43214-3455
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Country | US
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Telephone | 614-538-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 4735 S DURANGO DR SUITE #140
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City | LAS VEGAS
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State | NV
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Zip | 89147-8164
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Country | US
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Telephone | 702-403-1411
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Fax | 702-405-8165
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVID LEGRAND
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Credential |
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Telephone | 702-479-7587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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