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General NPI Number Information
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NPI Number | 1982719803
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Entity Type | Organization
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Legal Business Name | DESOTO MEMORIAL HOSPITAL INC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 900 N ROBERTS AVE
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City | ARCADIA
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State | FL
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Zip | 34266-8765
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Country | US
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Telephone | 863-494-3535
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Fax | 863-491-4328
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Provider Business Mailing Address
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Address Line | 900 N ROBERTS AVE
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City | ARCADIA
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State | FL
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Zip | 34266-8765
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Country | US
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Telephone | 863-494-3535
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Fax | 863-491-4328
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Authorized Official
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Title or Position | CEO
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Name | MR. VINCENT A SICA
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Credential |
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Telephone | 863-494-8403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 4218
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License Number State | FL
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