MEDICARE: BRD MANAGEMENT

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1104154236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRD MANAGEMENT

Provider Business Mailing Address
First Line	:	4735 S DURANGO DR
Second Line	:	SUITE #140
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8164
Country	:	US
Telephone Number	:	702-403-1411
Fax Number	:	702-405-8165

Provider Business Practice Location Address
First Line	:	3802 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3455
Country	:	US
Telephone Number	:	614-538-2200
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID LEGRAND
Credential	:
Telephone Number	:	702-479-7587

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	12/01/2009

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Directions to “BRD MANAGEMENT ” Practice Location

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