Provider Demographics
NPI:1427274075
Name:BROOKHAVEN MEDICAL CENTERS, INC.
Entity type:Organization
Organization Name:BROOKHAVEN MEDICAL CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V.P. OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-828-1991
Mailing Address - Street 1:1020 NE LOOP 410
Mailing Address - Street 2:SUITE 650
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1204
Mailing Address - Country:US
Mailing Address - Phone:210-828-1991
Mailing Address - Fax:
Practice Address - Street 1:1020 NE LOOP 410
Practice Address - Street 2:SUITE 650
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1204
Practice Address - Country:US
Practice Address - Phone:210-828-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation