=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821217456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BYRAM HEALTHCARE CENTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 08/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4135 MEGHAN BEELER CT SUITE 2
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46628-8409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-243-2510
-----------------------------------------------------
Fax | 574-243-2514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 277596
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30384-7596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-422-5516
-----------------------------------------------------
Fax | 770-590-8563
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO & PRESIDENT
-----------------------------------------------------
Name | MR. PERRY A BERNOCCHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-302-1600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 69000273A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------