| Bruyninckx Medical Llc | |
|
117 Ellington Dr Rayville LA 71269-3632 | |
| (318) 376-2189 | |
| Not Available |
| Full Name | Bruyninckx Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 117 Ellington Dr, Rayville, Louisiana |
| Authorized Official Name and Position | Kyle Bruyninckx (MD) |
| Authorized Official Contact | 3183762189 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruyninckx Medical Llc 117 Ellington Dr Rayville LA 71269-3632 Ph: (318) 376-2189 | Bruyninckx Medical Llc 117 Ellington Dr Rayville LA 71269-3632 Ph: (318) 376-2189 |
| NPI Number | 1700481660 |
|---|---|
| Provider Enumeration Date | 11/30/2020 |
| Last Update Date | 11/30/2020 |
| Medicare PECOS PAC ID | 2860807419 |
|---|---|
| Medicare Enrollment ID | O20210212001773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700481660 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Kyle B Bruyninckx |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972770378 PECOS PAC ID: 2163670688 Enrollment ID: I20120907000037 |
| Provider Name | Mikala Ramirez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851969877 PECOS PAC ID: 2769871763 Enrollment ID: I20211112001334 |
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