| Organization Name: | MEDBROOK MEDICAL ASSOCIATES INC |
| NPI Number: | 1013960632 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIM G BUGIN (VP PAYOR CONTRACTING) |
| Mailing Address: | 1370 Johnson Avenue Bridgeport |
| State: | WV US |
| Postal Code: | 263301382 |
| Phone Number: | 3048427186 |
| Fax Number: | 3048429005 |
| NPI Enumeration Date: | 05/17/2006 |
| NPI Last Update Date: | 02/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |