Provider Demographics
NPI:1023053774
Name:BRITELL, LLC
Entity type:Organization
Organization Name:BRITELL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-449-3859
Mailing Address - Street 1:1208 N GARTH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4056
Mailing Address - Country:US
Mailing Address - Phone:573-449-3859
Mailing Address - Fax:573-449-4187
Practice Address - Street 1:1208 N GARTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4056
Practice Address - Country:US
Practice Address - Phone:573-449-3859
Practice Address - Fax:573-449-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO182845OtherBLUE CROSS BLUE SHIELD
MO622961209Medicaid
MO61604OtherHEALTHCARE USA
MO61604OtherHEALTHCARE USA