Provider Demographics
NPI:1104154236
Name:BRD MANAGEMENT
Entity type:Organization
Organization Name:BRD MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-479-7587
Mailing Address - Street 1:4735 S DURANGO DR
Mailing Address - Street 2:SUITE #140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8164
Mailing Address - Country:US
Mailing Address - Phone:702-403-1411
Mailing Address - Fax:702-405-8165
Practice Address - Street 1:3802 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3455
Practice Address - Country:US
Practice Address - Phone:614-538-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty