Organization
BRENCO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. OLLIE BRENT (OFFICE MANAGER)
(601) 587-1367
Entity
Organization
Contact information
Practice address
157 F E SELLERS HWY, MONTICELLO, MS 39654
(601) 587-1367
(601) 587-0968
Mailing address
PO BOX 802, MONTICELLO, MS 39654-0802
(601) 587-1367
(601) 587-0968
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04156094
—
MS
Enumeration date
10/23/2006
Last updated
07/15/2010
Update your record
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