Provider Demographics
NPI:1023113305
Name:BRYAN INTERNAL MEDICINE SPECIALTIES, INC
Entity type:Organization
Organization Name:BRYAN INTERNAL MEDICINE SPECIALTIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS/CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:O
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE ADMIN
Authorized Official - Phone:330-343-6100
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-0249
Mailing Address - Country:US
Mailing Address - Phone:330-343-6100
Mailing Address - Fax:330-343-6133
Practice Address - Street 1:300 MEDICAL PARK DR
Practice Address - Street 2:204
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2073
Practice Address - Country:US
Practice Address - Phone:330-343-6100
Practice Address - Fax:330-343-6133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR9336431Medicare ID - Type Unspecified