MEDICARE: DESOTO 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	251E00000X	Home Health Agency	HHA20302095	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	:	1881706257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESOTO MEMORIAL HOSPITAL INC

Provider Business Mailing Address
First Line	:	1006 N MILLS AVE
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-8811
Country	:	US
Telephone Number	:	863-494-8432
Fax Number	:	863-494-7914

Provider Business Practice Location Address
First Line	:	1006 N MILLS AVE
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-8811
Country	:	US
Telephone Number	:	863-494-8432
Fax Number	:	863-494-7914

Authorized Official
Title or Position	:	CEO
Name	:	MR. VINCENT A SICA
Credential	:
Telephone Number	:	863-494-8403

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/12/2010

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