Organization
PAI PARTICIPANT 9 PA
Active
Organization
PAI PARTICIPANT 9 PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTAIN BRANTLEY (ACTING PRESIDENT)
(302) 300-5138
Entity
Organization
Contact information
Practice address
1373 N AVENUE C, ELGIN, TX 78621-1528
(512) 285-2457
Mailing address
PO BOX 639676, CINCINNATI, OH 45263-9676
(859) 291-4800
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
07/02/2019
Last updated
08/13/2026
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