Provider Demographics
NPI:1265469605
Name:FMC HOSPITAL, LTD.
Entity Type:Organization
Organization Name:FMC HOSPITAL, LTD.
Other - Org Name:FLORIDA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-436-2267
Mailing Address - Street 1:PO BOX 740944
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0944
Mailing Address - Country:US
Mailing Address - Phone:561-982-2189
Mailing Address - Fax:954-735-0532
Practice Address - Street 1:5000 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1503
Practice Address - Country:US
Practice Address - Phone:954-735-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4207282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
080084OtherHUMANA
953628180OtherAETNA US HEALTHCARE (NATI
275OtherBCBS OF FLORIDA
009228OtherAVMED
054953620OtherAETNA US HEALTHCARE (NATI
FL010214800Medicaid
990092OtherNEIGHBORHOOD HEALTH PLAN
650154753OtherWELL CARE HMO
65054753OtherCIGNA (US / PUERTO RICO)
111111111OtherCIGNA (US / PUERTO RICO)
111111111OtherCIGNA (US / PUERTO RICO)
=========OtherCIGNA (US / PUERTO RICO)
FL010214800Medicaid
65054753OtherCIGNA (US / PUERTO RICO)