Provider Demographics
NPI:1649769589
Name:BROAD TOP AREA MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:BROAD TOP AREA MEDICAL CENTER, INC
Other - Org Name:WALK IN CLINIC
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 1:4133 MEDICAL CENTER DR # 127
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 1:6678 TOWNE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-6934
Practice Address - Country:US
Practice Address - Phone:814-635-1232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROAD TOP AREA MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-07
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)