Provider Demographics
NPI:1326081282
Name:DOCTORS MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:DOCTORS MEMORIAL HOSPITAL INC
Other - Org Name:STEINHATCHEE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-223-5409
Mailing Address - Street 1:1209 1ST AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:STEINHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32359-2300
Mailing Address - Country:US
Mailing Address - Phone:352-498-5888
Mailing Address - Fax:358-495-7726
Practice Address - Street 1:1209 1ST AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:STEINHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:32359
Practice Address - Country:US
Practice Address - Phone:385-498-5888
Practice Address - Fax:352-498-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
10D0961934OtherCLIA
FL660092100Medicaid
103430Medicare ID - Type Unspecified