MEDICARE: SEBASTIAN HOSPITAL 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	:	1518296854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEBASTIAN HOSPITAL LLC

Provider Business Mailing Address
First Line	:	13695 US HIGHWAY 1
Second Line	:
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3230
Country	:	US
Telephone Number	:	772-664-8379
Fax Number	:	772-664-8677

Provider Business Practice Location Address
First Line	:	8000 RON BEATTY BLVD
Second Line	:	SUITE A1 AND A2
City	:	BAREFOOT BAY
State	:	FL
Zip	:	32976-7474
Country	:	US
Telephone Number	:	772-664-8379
Fax Number	:	772-664-8677

Authorized Official
Title or Position	:	SR. VP AND GENERAL COUNSEL
Name	:	TIMOTHY PARRY
Credential	:	ESQ
Telephone Number	:	239-598-3111

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	11/22/2011

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