=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649200601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CGH HOSPITAL, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 08/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 DOUGLAS RD
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-6914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-445-8461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 741215
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30374-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-982-2189
-----------------------------------------------------
Fax | 305-441-6879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF GOVT PROGRAMS, TENET
-----------------------------------------------------
Name | MR. CRAIG C. ARMIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-436-2267
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 4200
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------