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Brandon Scott Nidea

Student in an Organized Health Care Education/Training Program

Student, Health Care

PECOS Enrollment

This provider is enrolled in PECOS as BRANDON NIDEA.

Based on the most recent information from CMS, provider Brandon Scott Nidea is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 8 days ago.

Profile Details

Provider ID
1245810175
Provider Type
Individual
Full Name
Nidea, Brandon Scott
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
4/13/2021
Last Updated
4/13/2021

Contact Information

Practice Location

1 Wyoming St, Dayton, OH 45409-2722

(937) 208-8000

Unlisted Fax

Mailing Location

708 N Hamlin Ave, Park Ridge, IL 60068-2417

(847) 702-1488

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 390200000X Primary	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Brandon Scott Nidea

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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