Brian Richard Port (NPI# 1336133602, PAC ID# 0143395087) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1336133602 |
| PAC ID by PECOS | 0143395087 |
| Professional Enrollment ID | I20170315000863 |
| Full Name | Brian Richard Port |
| Address |
623 Memorial Ave N Allendale SC 29810-2715 |
| Gender | M |
| Medical School | ALBANY MEDICAL COLLEGE OF UNION UNIVERSITY |
| Graduation Year | 1980 |
| Primary Specialty | FAMILY MEDICINE |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 421300 | ALLENDALE COUNTY HOSPITAL |
| 420072 | HAMPTON REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 623 Memorial Ave N, Allendale, SC 29810-2715 | ||
| 1787 Allendale Fairfax Hwy, Fairfax, SC 29827-9133 |
| Street Address |
623 MEMORIAL AVE N |
| City | ALLENDALE |
| State | SC |
| Zip | 29810-2715 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amanda Beck Bucao | Nurse Practitioner | Ohio Valley Physicians Inc | 571 Memorial Ave N, Allendale, SC 29810-2713 |
| City | ALLENDALE |
| Zip Code | 29810 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | ALLENDALE + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Brian Richard Port.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.