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General NPI Number Information
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NPI Number | 1013960632
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Entity Type | Organization
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Legal Business Name | MEDBROOK MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 1370 JOHNSON AVENUE
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1382
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Country | US
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Telephone | 304-842-7186
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Fax | 304-842-9005
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Provider Business Mailing Address
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Address Line | PO BOX 719
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City | DELLSLOW
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State | WV
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Zip | 26531-0719
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Country | US
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Telephone | 304-842-7186
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Fax | 304-842-9005
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Authorized Official
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Title or Position | VP PAYOR CONTRACTING
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Name | MR. TIM G BUGIN
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Credential |
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Telephone | 304-225-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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