Healthcare Provider Details

I. General information

NPI: 1538400460
Provider Name (Legal Business Name): FISHERMEN'S HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 OVERSEAS HWY
MARATHON FL
33050-2329
US

IV. Provider business mailing address

3301 OVERSEAS HWY
MARATHON FL
33050-2329
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-5533
  • Fax: 305-743-8684
Mailing address:
  • Phone: 305-743-5533
  • Fax: 305-743-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number4389
License Number StateFL

VIII. Authorized Official

Name: DR. HAL W LEFTWICH DBA, FACHE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 305-289-6401