Organization
BROAD TOP AREA MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ROTH MD (CEO)
(814) 635-2916
Entity
Organization
Contact information
Practice address
4133 MEDICAL CENTER DRIVE, BOX 127, BROAD TOP, PA 16621-0127
(814) 635-2916
(814) 635-2918
Mailing address
4133 MEDICAL CENTER DRIVE, BOX 127, BROAD TOP, PA 16621-0127
(814) 635-2916
(814) 635-2918
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007496930006
—
PA
Enumeration date
09/05/2006
Last updated
04/22/2021
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