1285709451 NPI number — DOCTORS MEMORIAL HOSPITAL INC

Table of content: (NPI 1285709451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285709451 NPI number — DOCTORS MEMORIAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS MEMORIAL HOSPITAL INC
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:
Provider Other Organization Name Type Code:
6
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:
1285709451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 N BYRON BUTLER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERRY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32347-2300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-584-8404
Provider Business Mailing Address Fax Number:
850-584-3885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 N BYRON BUTLER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERRY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32347-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-584-0860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TIDWELL
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
850-223-5409

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 275448700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36645 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23466W . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 252009500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 275738900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53900 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 374283100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 279528100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24274 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 250953900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41469B . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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