1326335076 NPI number — HENDRY COUNTY HOSPITAL AUTHORITY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326335076 NPI number — HENDRY COUNTY HOSPITAL AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENDRY COUNTY HOSPITAL AUTHORITY
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:
HENDRY REGIONAL WOUND CARE AND HYPERBARIC MEDICINE
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:
1326335076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
542 W SAGAMORE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEWISTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33440-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-902-3052
Provider Business Mailing Address Fax Number:
863-983-6655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
542 W SAGAMORE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEWISTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33440-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-902-3052
Provider Business Practice Location Address Fax Number:
863-983-6655
Provider Enumeration Date:
07/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BEASLEY
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
863-902-3076

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  3995 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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