Provider Demographics
NPI:1225136021
Name:BRACKENRICH FAMILY PRACTICE, PLC
Entity Type:Organization
Organization Name:BRACKENRICH FAMILY PRACTICE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACKENRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-726-2375
Mailing Address - Street 1:PO BOX B
Mailing Address - Street 2:363 WOODLAND STREET
Mailing Address - City:RICH CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:24147-0336
Mailing Address - Country:US
Mailing Address - Phone:540-726-2375
Mailing Address - Fax:540-726-3573
Practice Address - Street 1:363 WOODLAND STREET
Practice Address - Street 2:
Practice Address - City:RICH CREEK
Practice Address - State:VA
Practice Address - Zip Code:24147-0336
Practice Address - Country:US
Practice Address - Phone:540-726-2375
Practice Address - Fax:540-726-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00241766806OtherADVANCED PRACTICE REGISTERED NURSE