MEDICARE: OCOEE REGIONAL HEALTH CORPORATION

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	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1386857381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCOEE REGIONAL HEALTH CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 308
Second Line	:
City	:	BENTON
State	:	TN
Zip	:	37307-0308
Country	:	US
Telephone Number	:	423-338-8995
Fax Number	:	423-338-8996

Provider Business Practice Location Address
First Line	:	6784 HIGHWAY 411
Second Line	:
City	:	BENTON
State	:	TN
Zip	:	37307-0308
Country	:	US
Telephone Number	:	423-338-8995
Fax Number	:	423-338-8996

Authorized Official
Title or Position	:	CEO
Name	:	MR. BILL R MOATS
Credential	:
Telephone Number	:	423-338-8995

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	06/29/2021

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Directions to “OCOEE REGIONAL HEALTH CORPORATION ” Practice Location

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