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General NPI Number Information
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NPI Number | 1811598683
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Entity Type | Organization
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Legal Business Name | MEDICAL ADRENALINE, LLC
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 529 CAPP HARLAN RD
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City | TOMPKINSVILLE
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State | KY
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Zip | 42167-1840
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Country | US
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Telephone | 270-487-9231
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Fax |
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Provider Business Mailing Address
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Address Line | 2161 S BOUNDARY RD
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City | RADCLIFF
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State | KY
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Zip | 40160-9686
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Country | US
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Telephone | 270-832-5389
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. BRIAN C. BRILL JR.
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Credential | DO
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Telephone | 270-832-5389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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