Provider Demographics
NPI:1134315799
Name:FLORIDA HOSPITAL HEALTHCARE SYSTEM, INC
Entity Type:Organization
Organization Name:FLORIDA HOSPITAL HEALTHCARE SYSTEM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP- CFO PHSO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-357-1649
Mailing Address - Street 1:2600 LUCIEN WAY
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7063
Mailing Address - Country:US
Mailing Address - Phone:407-357-3446
Mailing Address - Fax:
Practice Address - Street 1:2600 LUCIEN WAY
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7063
Practice Address - Country:US
Practice Address - Phone:407-357-3446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization