Provider Demographics
NPI:1538419502
Name:BROOKS - TLC HOSPITAL SYSTEM INC
Entity type:Organization
Organization Name:BROOKS - TLC HOSPITAL SYSTEM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LAROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-363-7207
Mailing Address - Street 1:529 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2514
Mailing Address - Country:US
Mailing Address - Phone:716-375-6490
Mailing Address - Fax:716-375-7583
Practice Address - Street 1:34 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070
Practice Address - Country:US
Practice Address - Phone:716-532-8100
Practice Address - Fax:716-532-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty