Provider Demographics
NPI:1457551236
Name:BRANNE LLC
Entity Type:Organization
Organization Name:BRANNE LLC
Other - Org Name:FOOTWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CPED
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:757-474-4220
Mailing Address - Street 1:5262 FAIRFIELD SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4212
Mailing Address - Country:US
Mailing Address - Phone:757-474-4220
Mailing Address - Fax:
Practice Address - Street 1:5262 FAIRFIELD SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4212
Practice Address - Country:US
Practice Address - Phone:757-474-4220
Practice Address - Fax:757-474-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4266290001Medicare NSC