Provider Demographics
NPI:1558195040
Name:BRISKE, TODD C
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:BRISKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BN MED HHC 1ST BN
Mailing Address - Street 2:1ST SWTG (A)
Mailing Address - City:CAMP MACKALL
Mailing Address - State:NC
Mailing Address - Zip Code:28347
Mailing Address - Country:US
Mailing Address - Phone:910-907-3525
Mailing Address - Fax:
Practice Address - Street 1:1 SPECIAL FORCES WAY
Practice Address - Street 2:
Practice Address - City:HOFFMAN
Practice Address - State:NC
Practice Address - Zip Code:28347
Practice Address - Country:US
Practice Address - Phone:910-907-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
07148615TBOtherATP