MEDICARE: FLAGLER HOSPITAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	3665	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144211020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLAGLER HOSPITAL INC

Provider Business Mailing Address
First Line	:	400 HEALTH PARK BLVD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-5784
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 HEALTH PARK BLVD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-5784
Country	:	US
Telephone Number	:	904-819-4500
Fax Number	:

Authorized Official
Title or Position	:	EVP/CHIEF ADMIN OFFICER
Name	:	MR. CARLTON DEVOOGHT
Credential	:
Telephone Number	:	904-819-4500

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	09/15/2022

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