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General NPI Number Information
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NPI Number | 1790920825
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH BIOMEDICAL RESEARCH, LLC
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 08/12/2009
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Provider Practice Location Address
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Address Line | 136 E PRINCETON ST
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City | CROFTON
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State | KY
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Zip | 42217-8018
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Country | US
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Telephone | 270-424-8885
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Fax | 270-424-5193
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Provider Business Mailing Address
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Address Line | 240 E AYR PKY
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City | MADISONVILLE
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State | KY
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Zip | 42431-8999
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Country | US
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Telephone | 270-825-8345
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Fax | 270-825-2975
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Authorized Official
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Title or Position | OWNER
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Name | BRET A. WITTMER
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Credential | D.V.M. / M.D.
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Telephone | 270-825-8345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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