MEDICARE: HOSPITAL OF SOUTH BEACH LLC

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

General Provider Information

NPI Number	:	1407921455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL OF SOUTH BEACH LLC

Provider Business Mailing Address
First Line	:	2026 W UNIVERSITY DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-0644
Country	:	US
Telephone Number	:	940-320-8100
Fax Number	:	940-320-0402

Provider Business Practice Location Address
First Line	:	630 ALTON RD
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-5502
Country	:	US
Telephone Number	:	305-538-9418
Fax Number	:	305-598-9418

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER, VP
Name	:	MR. THOMAS EDWARD ROURKE
Credential	:	LCSW
Telephone Number	:	940-320-8100

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	08/22/2020

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