Healthcare Provider Details

I. General information

NPI: 1336937408
Provider Name (Legal Business Name): HENDRY COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 W SAGAMORE AVE BLDG E
CLEWISTON FL
33440-3514
US

IV. Provider business mailing address

542 W SAGAMORE AVE BLDG E
CLEWISTON FL
33440-3514
US

V. Phone/Fax

Practice location:
  • Phone: 863-983-6186
  • Fax: 863-254-3011
Mailing address:
  • Phone: 863-983-6186
  • Fax: 863-254-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID MICHAEL THEROUX
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 863-902-3051