Provider Demographics
NPI:1326211103
Name:DR JAMES T BROM PSC
Entity Type:Organization
Organization Name:DR JAMES T BROM PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-836-8153
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-0963
Mailing Address - Country:US
Mailing Address - Phone:606-836-8153
Mailing Address - Fax:606-834-9420
Practice Address - Street 1:2135 ARGILLITE RD STE J
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1629
Practice Address - Country:US
Practice Address - Phone:606-836-8153
Practice Address - Fax:606-834-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0927DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050261OtherBLUE CROSS BLUE SHIELD
KY77009272Medicaid
KYP00799091Medicare PIN
KY000000050261OtherBLUE CROSS BLUE SHIELD
KYT54725Medicare UPIN
KY77009272Medicaid
KY9237501Medicare PIN
KY0579800001Medicare NSC