Provider Demographics
NPI:1275060816
Name:BRIOMD PHYSICIANS
Entity Type:Organization
Organization Name:BRIOMD PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAGARUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-319-3951
Mailing Address - Street 1:814 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4259
Mailing Address - Country:US
Mailing Address - Phone:601-909-6274
Mailing Address - Fax:
Practice Address - Street 1:814 W PINE ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4259
Practice Address - Country:US
Practice Address - Phone:601-909-6274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory