Provider Demographics
NPI:1104808492
Name:BROOKFIELD TOWNSHIP
Entity type:Organization
Organization Name:BROOKFIELD TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MASIROVITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-448-1000
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:330-448-1000
Mailing Address - Fax:330-448-4262
Practice Address - Street 1:774 STATE ROUTE 7 NE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403-9630
Practice Address - Country:US
Practice Address - Phone:330-448-1000
Practice Address - Fax:330-448-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188836Medicaid
PA0016410380003Medicaid
000000155959OtherANTHEM
OH0188836Medicaid
PA0016410380003Medicaid
=========00OtherWORK COMP OHIO
PA0016410380003Medicaid