=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093791303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORTON PLANT HOSPITAL ASSOCIATION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2005
-----------------------------------------------------
Last Update Date | 08/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 CORBETT ST
-----------------------------------------------------
City | BELLEAIR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756-3344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-462-7600
-----------------------------------------------------
Fax | 727-298-6064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 CORBETT ST
-----------------------------------------------------
City | BELLEAIR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756-3344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-462-7600
-----------------------------------------------------
Fax | 727-298-6064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO, BAYCARE HOSPITAL DIVISION
-----------------------------------------------------
Name | MR. CARL TREMONTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-462-7176
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | SNF1358095
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------