Healthcare Provider Details

I. General information

NPI: 1326335076
Provider Name (Legal Business Name): HENDRY COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 W SAGAMORE AVE
CLEWISTON FL
33440-3514
US

IV. Provider business mailing address

542 W SAGAMORE AVE
CLEWISTON FL
33440-3514
US

V. Phone/Fax

Practice location:
  • Phone: 863-902-3052
  • Fax: 863-983-6655
Mailing address:
  • Phone: 863-902-3052
  • Fax: 863-983-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number3995
License Number StateFL

VIII. Authorized Official

Name: MR. LYNN W. BEASLEY
Title or Position: CEO
Credential: CEO
Phone: 863-902-3076