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General NPI Number Information
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NPI Number | 1508541798
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Entity Type | Organization
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Legal Business Name | BRAVO HEALTH MID-ATLANTIC, INC.
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 9623 BRAEBURN GLN
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City | AUSTIN
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State | TX
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Zip | 78729-2710
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Country | US
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Telephone | 512-534-7482
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Fax |
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Provider Business Mailing Address
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Address Line | 500 GREAT CIRCLE RD
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City | NASHVILLE
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State | TN
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Zip | 37228-1309
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Country | US
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Telephone | 571-401-5886
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Fax |
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Authorized Official
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Title or Position | ATTORNEY
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Name | MRS. MARLENA POWELL PICKERING
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Credential | ESQ.
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Telephone | 571-401-5886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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