Provider Demographics
NPI:1356778773
Name:BROOKVILLE HOSPITAL
Entity type:Organization
Organization Name:BROOKVILLE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-849-1408
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1367
Mailing Address - Country:US
Mailing Address - Phone:814-927-5609
Mailing Address - Fax:814-927-5613
Practice Address - Street 1:125 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:MARIENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16239-0463
Practice Address - Country:US
Practice Address - Phone:814-927-5609
Practice Address - Fax:814-927-5613
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENN HIGHLANDS HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-30
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100773376Medicaid