Provider Demographics
NPI:1225225444
Name:SPRINGBROOK HOSPITAL
Entity Type:Organization
Organization Name:SPRINGBROOK HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-597-5075
Mailing Address - Street 1:7007 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8610
Mailing Address - Country:US
Mailing Address - Phone:352-597-5075
Mailing Address - Fax:352-597-9644
Practice Address - Street 1:13406 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6822
Practice Address - Country:US
Practice Address - Phone:352-597-5075
Practice Address - Fax:352-597-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30418OtherBCBS
FL32507OtherBCBS