Provider Demographics
NPI:1811598683
Name:MEDICAL ADRENALINE, LLC
Entity type:Organization
Organization Name:MEDICAL ADRENALINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:270-832-5389
Mailing Address - Street 1:2161 S BOUNDARY RD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-9686
Mailing Address - Country:US
Mailing Address - Phone:270-832-5389
Mailing Address - Fax:
Practice Address - Street 1:529 CAPP HARLAN RD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1840
Practice Address - Country:US
Practice Address - Phone:270-487-9231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty