Provider Demographics
NPI:1174039408
Name:BROAD TOP AREA MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:BROAD TOP AREA MEDICAL CENTER, INC
Other - Org Name:MOUNT UNION AREA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-635-2916
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:BROAD TOP
Mailing Address - State:PA
Mailing Address - Zip Code:16621-0127
Mailing Address - Country:US
Mailing Address - Phone:814-635-7351
Mailing Address - Fax:814-635-7354
Practice Address - Street 1:95 S PARK ST
Practice Address - Street 2:
Practice Address - City:MOUNT UNION
Practice Address - State:PA
Practice Address - Zip Code:17066-1334
Practice Address - Country:US
Practice Address - Phone:815-542-8627
Practice Address - Fax:814-542-5444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROAD TOP AREA MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)