Healthcare Provider Details

I. General information

NPI: 1902010770
Provider Name (Legal Business Name): OCOEE REGIONAL HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 SR 56
COALMONT TN
37313-2505
US

IV. Provider business mailing address

PO BOX 70
PALMER TN
37365-0070
US

V. Phone/Fax

Practice location:
  • Phone: 931-779-4002
  • Fax: 931-779-4003
Mailing address:
  • Phone: 931-779-4002
  • Fax: 931-779-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. BILL R MOATS
Title or Position: CEO
Credential:
Phone: 423-338-8995