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NPI Code Detail

MEDICARE: BRYAN OPCO LLC

MEDICARE: BRYAN OPCO LLC
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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1215404330
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRYAN OPCO LLC
Provider Business Mailing Address
First Line : 2431 S ACADIAN THRUWAY STE 100
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-2300
Country : US
Telephone Number : 225-800-4954
Fax Number : 225-308-2278
Provider Business Practice Location Address
First Line : 2817 KENT ST
Second Line :
City : BRYAN
State : TX
Zip : 77802-5214
Country : US
Telephone Number : 979-776-7521
Fax Number : 979-774-0161
Authorized Official
Title or Position : MANAGER
Name : VICTOR DEVIN GUM
Credential :
Telephone Number : 225-800-4954
Provider Enumeration Date : 10/26/2018
Last Update Date : 11/29/2023

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Directions to “BRYAN OPCO LLC ” Practice Location

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