1366431702 NPI number — HOLMES COUNTY HOSPITAL CORP

Table of content: (NPI 1366431702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366431702 NPI number — HOLMES COUNTY HOSPITAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLMES COUNTY HOSPITAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DOCTORS MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366431702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONIFAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-547-8015
Provider Business Mailing Address Fax Number:
850-547-8025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONIFAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-547-8015
Provider Business Practice Location Address Fax Number:
850-547-8025
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
JOANN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
850-547-8001

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  4427 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010103600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010103602 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH0342 . This is a "MEDICARE RAIL ROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 428 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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