Provider Demographics
NPI:1396796553
Name:BROOKRIDGE INTERNAL MEDICINE ASSOCIATES, PA
Entity type:Organization
Organization Name:BROOKRIDGE INTERNAL MEDICINE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VOZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-315-2907
Mailing Address - Street 1:300 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6505
Mailing Address - Country:US
Mailing Address - Phone:903-315-2907
Mailing Address - Fax:903-315-2927
Practice Address - Street 1:300 N 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601
Practice Address - Country:US
Practice Address - Phone:903-315-2907
Practice Address - Fax:903-315-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6399207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161382002Medicaid
TX00778TMedicare PIN