Provider Demographics
NPI:1376536276
Name:VILLAGE OF BRADNER
Entity type:Organization
Organization Name:VILLAGE OF BRADNER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-288-2890
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:
Practice Address - Street 1:117 E CROCKER ST
Practice Address - Street 2:
Practice Address - City:BRADNER
Practice Address - State:OH
Practice Address - Zip Code:43406-9805
Practice Address - Country:US
Practice Address - Phone:419-288-2890
Practice Address - Fax:419-288-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000156053OtherANTHEM BLUE CROSS
10202OtherPARAMOUNT
OH0135713Medicaid
791590551OtherRAILROAD MEDICARE