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General NPI Number Information
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NPI Number | 1124296678
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Entity Type | Organization
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Legal Business Name | STADION INPATIENT SERVICES LLC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 1400 FIVAY ROAD
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City | HUDSON
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State | FL
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Zip | 34667
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Country | US
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Telephone | 469-401-2386
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Fax |
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Provider Business Mailing Address
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Address Line | 13737 NOEL RD STE 1600
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City | DALLAS
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State | TX
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Zip | 75240-1331
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Country | US
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Telephone | 469-401-2386
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Fax | 214-712-2444
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY J BRYNE
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Credential | M.D.
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Telephone | 469-401-2386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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