1417331554 NPI number — BROOKVILLE HOSPITAL

Table of content: (NPI 1417331554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417331554 NPI number — BROOKVILLE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKVILLE HOSPITAL
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:
PENN HIGHLANDS BROOKVILLE MOSHANNON VALLEY RHC
Provider Other Organization Name Type Code:
5
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:
1417331554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HOSPITAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15825-1367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
271 RAILROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-9701
Provider Business Practice Location Address Fax Number:
814-342-7506
Provider Enumeration Date:
07/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PEER
Authorized Official First Name:
JULIANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
814-849-1461

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100773376-0049 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 393430 . This is a "PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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