MEDICARE: BROAD TOP AREA MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1871066191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROAD TOP AREA MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	4133 MEDICAL CENTER DR
Second Line	:
City	:	BROAD TOP
State	:	PA
Zip	:	16621-9001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6311 MARGY DR
Second Line	:
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-7565
Country	:	US
Telephone Number	:	814-506-8490
Fax Number	:	814-506-8493

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	SHANI REED
Credential	:
Telephone Number	:	814-506-8463

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	09/14/2023

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