Healthcare Provider Details

I. General information

NPI: 1346490273
Provider Name (Legal Business Name): DESOTO MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N ROBERTS AVE
ARCADIA FL
34266-8712
US

IV. Provider business mailing address

900 N ROBERTS AVE
ARCADIA FL
34266-8712
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-3535
  • Fax: 863-491-4244
Mailing address:
  • Phone: 863-494-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number4218
License Number StateFL

VIII. Authorized Official

Name: VINCE SICA
Title or Position: CEO/PRESIDENT
Credential:
Phone: 863-494-3535