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General NPI Number Information
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NPI Number | 1235275579
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Entity Type | Organization
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Legal Business Name | BLUEFIELD WOMENS CENTER PC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 504A CHERRY ST
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City | BLUEFIELD
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State | WV
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Zip | 24701-3306
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Country | US
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Telephone | 304-327-0531
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Fax | 304-327-6834
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Provider Business Mailing Address
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Address Line | 504A CHERRY ST
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City | BLUEFIELD
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State | WV
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Zip | 24701-3306
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Country | US
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Telephone | 304-327-0531
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Fax | 304-327-6834
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDY M BRODNIK
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Credential | DO FACOG
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Telephone | 304-327-0531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 1566
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License Number State | WV
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