Provider Demographics
NPI:1235275579
Name:BLUEFIELD WOMENS CENTER PC
Entity Type:Organization
Organization Name:BLUEFIELD WOMENS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRODNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO FACOG
Authorized Official - Phone:304-327-0531
Mailing Address - Street 1:504A CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3306
Mailing Address - Country:US
Mailing Address - Phone:304-327-0531
Mailing Address - Fax:304-327-6834
Practice Address - Street 1:504A CHERRY ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3306
Practice Address - Country:US
Practice Address - Phone:304-327-0531
Practice Address - Fax:304-327-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1566207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0093390000Medicaid
VA6210970OtherMEDICAID
WVBR0784454Medicare ID - Type Unspecified
WVP52878Medicare UPIN