Provider Demographics
NPI:1144325556
Name:BYRAM HEALTHCARE CENTERS, INC
Entity type:Organization
Organization Name:BYRAM HEALTHCARE CENTERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERNOCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-286-2000
Mailing Address - Street 1:3131 S WILLOW AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93725-9349
Mailing Address - Country:US
Mailing Address - Phone:559-256-7988
Mailing Address - Fax:866-514-2911
Practice Address - Street 1:3131 S WILLOW AVE
Practice Address - Street 2:STE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-9349
Practice Address - Country:US
Practice Address - Phone:559-256-7988
Practice Address - Fax:866-514-2911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BYRAM HOLDINGS I, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY492553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA470430Medicaid
CA1144325556Medicaid
0523402OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA0228430014Medicare NSC