Provider Demographics
NPI:1457302614
Name:HUNTINGDON HEALTHCARE INC
Entity Type:Organization
Organization Name:HUNTINGDON HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:UTTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-330-7976
Mailing Address - Street 1:1012 GOODLETTE-FRANK RD N STE 100
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5463
Mailing Address - Country:US
Mailing Address - Phone:239-330-7976
Mailing Address - Fax:
Practice Address - Street 1:1012 GOODLETTE-FRANK RD N STE 100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5463
Practice Address - Country:US
Practice Address - Phone:239-330-7976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266828900Medicaid