Provider Demographics
NPI:1821232406
Name:BRMS OB/GYN
Entity Type:Organization
Organization Name:BRMS OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PRACTICE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:814-362-8277
Mailing Address - Street 1:116 INTERSTATE PKWY
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1036
Mailing Address - Country:US
Mailing Address - Phone:814-368-3123
Mailing Address - Fax:
Practice Address - Street 1:159 INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1013
Practice Address - Country:US
Practice Address - Phone:814-368-3123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADFORD REGIONAL MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-27
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024058E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023263Medicare PIN