1366592958 NPI number — KYLE C BRYANS M.D.

Table of content: KYLE C BRYANS M.D. (NPI 1366592958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366592958 NPI number — KYLE C BRYANS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYANS
Provider First Name:
KYLE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366592958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29624-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-226-0511
Provider Business Mailing Address Fax Number:
864-231-7018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 N FANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29621-5708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-226-0511
Provider Business Practice Location Address Fax Number:
864-231-7018
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  18330 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 57-0853635 . This is a "BLUE CROSS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: T23196 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00693932A . This is a "MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 300062967 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 57-0853635 . This is a "CHAMPUS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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