Provider Demographics
NPI:1215009691
Name:BRUCE SNIDER MD PSC
Entity type:Organization
Organization Name:BRUCE SNIDER MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-341-5014
Mailing Address - Street 1:510 GRAVES AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-3309
Mailing Address - Country:US
Mailing Address - Phone:859-341-5014
Mailing Address - Fax:859-341-5136
Practice Address - Street 1:510 GRAVES AVE STE 210
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-3309
Practice Address - Country:US
Practice Address - Phone:859-341-5014
Practice Address - Fax:859-341-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64168354Medicaid
KY2086Medicare PIN
KYC71581Medicare UPIN