1689693293 NPI number — OCOEE HOSPITAL CORPORATION

Table of content: (NPI 1689693293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689693293 NPI number — OCOEE HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCOEE HOSPITAL CORPORATION
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:
BRADLEY 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:
1689693293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 403914
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-3914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 CHAMBLISS AVE NW
Provider Second Line Business Practice Location Address:
POB 3060
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37311-3847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-559-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUSSEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP, GROUP OPERATIONS
Authorized Official Telephone Number:
888-373-9600

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0000000031 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4400024 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4111694 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 241517 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00000228A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0200937 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01621945 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: A3731101 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4111694 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 440024 . This is a "CARITEN" identifier . This identifiers is of the category "OTHER".




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