Provider Demographics
NPI:1669688909
Name:JIMMY C. BRASFIELD, PC
Entity Type:Organization
Organization Name:JIMMY C. BRASFIELD, PC
Other - Org Name:BRISTOL NEUROSURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRASFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-844-6407
Mailing Address - Street 1:PO BOX 17016
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24209-7016
Mailing Address - Country:US
Mailing Address - Phone:423-844-6407
Mailing Address - Fax:866-769-7784
Practice Address - Street 1:320 BRISTOL WEST BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-8765
Practice Address - Country:US
Practice Address - Phone:423-844-6407
Practice Address - Fax:888-769-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3372399Medicare PIN