Provider Demographics
NPI:1801064332
Name:BRYAN LUVERNE FINLEY
Entity type:Organization
Organization Name:BRYAN LUVERNE FINLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:LUVERNE
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:507-663-1650
Mailing Address - Street 1:6559 145TH ST E
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-4617
Mailing Address - Country:US
Mailing Address - Phone:507-663-1650
Mailing Address - Fax:507-663-1352
Practice Address - Street 1:6559 145TH ST E
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-4617
Practice Address - Country:US
Practice Address - Phone:507-663-1650
Practice Address - Fax:507-663-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1801064332Medicare NSC
0137010001Medicare NSC