Provider Demographics
NPI:1659487023
Name:BELVEDERE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BELVEDERE MEDICAL CORPORATION
Other - Org Name:BMC FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRANSCUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:717-243-1515
Mailing Address - Street 1:850 WALNUT BOTTOM ROAD
Mailing Address - Street 2:HOLLEN KRETZING
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3632
Mailing Address - Country:US
Mailing Address - Phone:717-243-1515
Mailing Address - Fax:717-243-7171
Practice Address - Street 1:850 WALNUT BOTTOM ROAD
Practice Address - Street 2:HOLLEN KRETZING
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3632
Practice Address - Country:US
Practice Address - Phone:717-243-1515
Practice Address - Fax:717-243-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037595OtherHIGHMARK BLUE SHIELD
PA50000727OtherCAP BLUE CROSS
PA0006561610001Medicaid
PA037595OtherHIGHMARK BLUE SHIELD