1477599975 NPI number — WINTER HAVEN HOSPITAL INC

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 1477599975 NPI number — WINTER HAVEN HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINTER HAVEN 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:
1477599975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2995 DREW ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33759-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-281-9390
Provider Business Mailing Address Fax Number:
813-635-2613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 AVE F NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-293-1121
Provider Business Practice Location Address Fax Number:
813-635-2613
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUBERO
Authorized Official First Name:
TAMBLYN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
MANAGER, CBO FINANCE
Authorized Official Telephone Number:
727-281-9257

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 3974 , 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)

  • Identifier: 010169900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98943 . This is a "BC 1500" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010169903 . This is a "MEDICAID UB" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 507 . This is a "BC UB" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 060611101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060611100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223 . This is a "BCBSF" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: C11283 . This is a "MEDICARE RAILROAD 1500" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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