MEDICARE: CHARLES BRENTNALL, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	00007246	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	510-02286	OTHER	AL	BCBS OF ALABAMA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C71170	OTHER	AL	UPIN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	510-19927	OTHER	AL	BCBS OF ALABAMA

General Provider Information

NPI Number	:	1023280716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES BRENTNALL, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 2190
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-5190
Country	:	US
Telephone Number	:	256-249-0358
Fax Number	:	256-249-8508

Provider Business Practice Location Address
First Line	:	7 BROWN AVE
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2421
Country	:	US
Telephone Number	:	256-249-0358
Fax Number	:	256-249-8508

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES B BRENTNALL
Credential	:	MD
Telephone Number	:	256-249-0358

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	05/01/2008

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Directions to “CHARLES BRENTNALL, M.D., P.A. ” Practice Location

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