Provider Demographics
NPI:1336221035
Name:BROADCREEK MEDICAL SERVICE INC
Entity Type:Organization
Organization Name:BROADCREEK MEDICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOD
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:EMEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-629-0202
Mailing Address - Street 1:1601 MIDDLEFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973
Mailing Address - Country:US
Mailing Address - Phone:302-629-0202
Mailing Address - Fax:302-629-9382
Practice Address - Street 1:1601 MIDDLEFORD ROAD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973
Practice Address - Country:US
Practice Address - Phone:302-629-0202
Practice Address - Fax:302-629-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000117816Medicaid
DE0000117816Medicaid