Provider Demographics
NPI:1760679021
Name:BRALEY & THOMPSON
Entity Type:Organization
Organization Name:BRALEY & THOMPSON
Other - Org Name:BRALEY & THOMPSON - VIRGINIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMBRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-394-2387
Mailing Address - Street 1:9901 LINN STATION ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223
Mailing Address - Country:US
Mailing Address - Phone:800-866-0860
Mailing Address - Fax:
Practice Address - Street 1:1 DUNBAR PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3038
Practice Address - Country:US
Practice Address - Phone:800-866-0860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0002002217Medicaid
VA0002002043Medicaid
VA010195853Medicaid
VA0002002126Medicaid
VA010080479Medicaid
VA010237921Medicaid
VA0102834857Medicaid
VA0100149811Medicaid
VA010387680Medicaid
VA0002002399Medicaid
VA010246563Medicaid
VA008945845Medicaid