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General NPI Number Information
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NPI Number | 1326335076
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Entity Type | Organization
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Legal Business Name | HENDRY COUNTY HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 542 W SAGAMORE AVE
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City | CLEWISTON
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State | FL
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Zip | 33440-3514
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Country | US
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Telephone | 863-902-3052
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Fax | 863-983-6655
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Provider Business Mailing Address
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Address Line | 542 W SAGAMORE AVE
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City | CLEWISTON
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State | FL
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Zip | 33440-3514
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Country | US
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Telephone | 863-902-3052
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Fax | 863-983-6655
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Authorized Official
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Title or Position | CEO
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Name | MR. LYNN W. BEASLEY
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Credential | CEO
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Telephone | 863-902-3076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 3995
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License Number State | FL
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