Provider Demographics
NPI:1568035590
Name:BROAD TOP AREA MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:BROAD TOP AREA MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-506-8463
Mailing Address - Street 1:4133 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BROAD TOP
Mailing Address - State:PA
Mailing Address - Zip Code:16621-9001
Mailing Address - Country:US
Mailing Address - Phone:814-635-2916
Mailing Address - Fax:814-635-2918
Practice Address - Street 1:626 WATER ST STE 1
Practice Address - Street 2:
Practice Address - City:ORBISONIA
Practice Address - State:PA
Practice Address - Zip Code:17243-9432
Practice Address - Country:US
Practice Address - Phone:814-447-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROAD TOP AREA MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)