Provider Demographics
NPI:1942558432
Name:BROOKS CORP
Entity Type:Organization
Organization Name:BROOKS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-564-8000
Mailing Address - Street 1:1601 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3259
Mailing Address - Country:US
Mailing Address - Phone:406-564-8000
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3259
Practice Address - Country:US
Practice Address - Phone:406-564-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1234207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty