Provider Demographics
NPI:1912142423
Name:DR. JOHN BRIODY
Entity Type:Organization
Organization Name:DR. JOHN BRIODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-735-6411
Mailing Address - Street 1:3200 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4292
Mailing Address - Country:US
Mailing Address - Phone:715-735-6411
Mailing Address - Fax:715-735-6417
Practice Address - Street 1:3200 SHORE DR
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4292
Practice Address - Country:US
Practice Address - Phone:715-735-6411
Practice Address - Fax:715-735-6417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHREACH HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40160Medicare PIN