Provider Demographics
NPI:1073543799
Name:HOLLYWOOD MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:HOLLYWOOD MEDICAL CENTER, INC.
Other - Org Name:HOLLYWOOD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF TAXATION, TENET HEALTHCARE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2530
Mailing Address - Street 1:PO BOX 532976
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-2976
Mailing Address - Country:US
Mailing Address - Phone:561-982-2189
Mailing Address - Fax:954-985-6245
Practice Address - Street 1:3600 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8216
Practice Address - Country:US
Practice Address - Phone:954-966-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4416282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
009279OtherAVMED
FL011179100Medicaid
990121OtherNEIGHBORHOOD HEALTH PLAN
080087OtherHUMANA
NY1611343Medicaid
100225B000000OtherSECTION 1011
280OtherBCBS OF FLORIDA
433263410OtherAETNA US HEALTHCARE (NATI