Provider Demographics
NPI:1578561395
Name:RON BRICKEY ASSOC PC
Entity Type:Organization
Organization Name:RON BRICKEY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-982-9541
Mailing Address - Street 1:1037 WATER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-4408
Mailing Address - Country:US
Mailing Address - Phone:810-982-9541
Mailing Address - Fax:810-982-5349
Practice Address - Street 1:1037 WATER ST STE 2
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4408
Practice Address - Country:US
Practice Address - Phone:810-982-9541
Practice Address - Fax:810-982-5349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30693OtherBCBS
MI234513Medicare ID - Type UnspecifiedMEDICARE