Provider Demographics
NPI:1417241100
Name:BRETTON MEDICAL LLC
Entity Type:Organization
Organization Name:BRETTON MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALTZBURG
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:814-946-9909
Mailing Address - Street 1:615 HOWARD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4813
Mailing Address - Country:US
Mailing Address - Phone:814-946-9909
Mailing Address - Fax:888-615-0278
Practice Address - Street 1:615 HOWARD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4813
Practice Address - Country:US
Practice Address - Phone:814-946-9909
Practice Address - Fax:888-615-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000007793332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6609180001Medicare NSC