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Organization
WORSHIP AND PRAISES PENTECOSTAL
Active
Organization
WORSHIP AND PRAISES PENTECOSTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD BRISCO BS RRT CRTT NA (DIRECTOR)
(804) 687-1054
Entity
Organization
Contact information
Practice address
4011 NEWBYS BRIDGE RD, CHESTERFIELD, VA 23832-7722
(804) 687-1054
(804) 454-3080
Mailing address
4011 NEWBYS BRIDGE RD, CHESTERFIELD, VA 23832-7722
(804) 687-1054
(804) 454-3080
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0117004528
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0117004528
BOARD OF MEDICINE
VA
Enumeration date
11/11/2010
Last updated
11/11/2010
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