=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275902124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGES TRI-COUNTY MEDICAL CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2015
-----------------------------------------------------
Last Update Date | 12/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1451 EL CAMINO REAL
-----------------------------------------------------
City | THE VILLAGES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32159-0041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-751-8000
-----------------------------------------------------
Fax | 352-751-8011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 CHILDS STREET
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34748-5994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-323-2002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | HEATHER LONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-323-5001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------