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1417901406

NPI Code Detail

MEDICARE: FAWCETT MEMORIAL HOSPITAL, INC.

MEDICARE: FAWCETT MEMORIAL 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	273Y00000X	Rehabilitation Hospital Unit
2	282N00000X	General Acute Care Hospital

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
2	571	OTHER	FL	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0007175	OTHER		AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	032064700	OTHER		BLACK LUNG
7	20320	OTHER		WELLCARE/STAYWELL
8	20320	OTHER	GA	WELLCARE
9	000035953	OTHER	FL	HUMANA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417901406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAWCETT MEMORIAL HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	21298 OLEAN BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6705
Country	:	US
Telephone Number	:	941-629-1181
Fax Number	:	941-627-6142

Provider Business Practice Location Address
First Line	:	21298 OLEAN BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6705
Country	:	US
Telephone Number	:	941-629-1181
Fax Number	:	941-627-6142

Authorized Official
Title or Position	:	CFO
Name	:	RICK SCHRADER
Credential	:
Telephone Number	:	941-629-1181

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	11/07/2025

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Directions to “FAWCETT MEMORIAL HOSPITAL, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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