Provider Demographics
NPI:1730242660
Name:BROCKIE HEALTHCARE INCORPORATED
Entity type:Organization
Organization Name:BROCKIE HEALTHCARE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-843-1541
Mailing Address - Street 1:209 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5321
Mailing Address - Country:US
Mailing Address - Phone:717-843-1541
Mailing Address - Fax:717-852-9607
Practice Address - Street 1:209 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5321
Practice Address - Country:US
Practice Address - Phone:717-843-1541
Practice Address - Fax:717-852-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007508720004Medicaid
PA1007508720004Medicaid