RICHARD C BRANDES MD INC

Provider Demographics

• NPI: 1871510438
• Name: RICHARD C BRANDES MD INC
• Entity Type: Organization
• Organization Name: RICHARD C BRANDES MD INC
• Other - Org Name: VILLAGE FAMILY MEDICINE
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - First Name: ELIZABETH
• Authorized Official - Middle Name: A
• Authorized Official - Last Name: WEINSTOCK
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 614-299-5838
• Mailing Address - Street 1: 4845 KNIGHTSBRIDGE BLVD
• Mailing Address - Street 2: SUITE 220
• Mailing Address - City: COLUMBUS
• Mailing Address - State: OH
• Mailing Address - Zip Code: 43214-2463
• Mailing Address - Country: US
• Mailing Address - Phone: 614-299-5838
• Mailing Address - Fax: 614-299-5929
• Practice Address - Street 1: 4845 KNIGHTSBRIDGE BLVD
• Practice Address - Street 2: SUITE 220
• Practice Address - City: COLUMBUS
• Practice Address - State: OH
• Practice Address - Zip Code: 43214-2463
• Practice Address - Country: US
• Practice Address - Phone: 614-299-5838
• Practice Address - Fax: 614-299-5929
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-07-17
• Last Update Date: 2015-12-14

Provider Licenses

State	License ID	Taxonomies
		207Q00000X
OH	35083346	207Q00000X
OH	35075510B	207Q00000X
OH	35071127W	207Q00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OH	2127997	Medicaid
OH	9300901	Medicare PIN
OH	2127997	Medicaid
OH	9300901	Medicare PIN
	H69979	Medicare UPIN
OH	9300901	Medicare ID - Type Unspecified
OH	2127997	Medicaid
	35079071 L	Other	STATE LICENSE
	35083346	Other	STATE LICENSE
	9300901	Other	MDC
	BT 8774247	Other	DEA
OH	2190927	Medicaid
OH	2350003	Medicaid
	4017853	Other	MDC
	CM5831	Other	RR MEDICARE
OH	2051621	Medicaid
	35071127 W	Other	STATE LICENSE
	4091601	Other	MDC
	4147712	Other	MDC
	I21871	Medicare UPIN
OH	2481443	Medicaid
	BJ 5180081	Other	DEA