Provider Demographics
NPI:1750722880
Name:RICHARD WARREN BRINKMAN INC
Entity type:Organization
Organization Name:RICHARD WARREN BRINKMAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:BRINKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-782-8866
Mailing Address - Street 1:1711 DESTINY LN
Mailing Address - Street 2:SUITE 118
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1066
Mailing Address - Country:US
Mailing Address - Phone:270-782-8866
Mailing Address - Fax:270-715-8346
Practice Address - Street 1:1711 DESTINY LN
Practice Address - Street 2:SUITE 118
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1066
Practice Address - Country:US
Practice Address - Phone:270-782-8866
Practice Address - Fax:270-715-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38409261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64077696Medicaid
KY64077696Medicaid