1649769589 NPI number — BROAD TOP AREA MEDICAL CENTER, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649769589 NPI number — BROAD TOP AREA MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROAD TOP AREA MEDICAL CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649769589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4133 MEDICAL CENTER DR # 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROAD TOP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16621-9001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-635-2916
Provider Business Mailing Address Fax Number:
814-635-2918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6678 TOWNE CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16652-6934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-635-1232
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ROTH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
814-635-2916

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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