Provider Demographics
NPI: | 1467401877 |
---|---|
Name: | HOLY CROSS HOSPITAL INC |
Entity Type: | Organization |
Organization Name: | HOLY CROSS HOSPITAL INC |
Other - Org Name: | HOLY CROSS MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARK |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | DOYLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 954-771-8000 |
Mailing Address - Street 1: | PO BOX 531853 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30353-1853 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-351-4702 |
Mailing Address - Fax: | 954-351-4736 |
Practice Address - Street 1: | 4725 N FEDERAL HIGHWAY |
Practice Address - Street 2: | HCMG BILLING DEPARTMENT |
Practice Address - City: | FT. LAUDERDALE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33308 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-351-4702 |
Practice Address - Fax: | 954-351-4705 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-10 |
Last Update Date: | 2024-03-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207Q00000X, 207QA0000X, 207QA0505X, 207QG0300X, 207RA0000X, 207RC0000X, 207RE0101X, 207RG0100X, 207RG0300X, 207RH0003X, 207RP1001X, 207RR0500X, 207U00000X, 207V00000X | ||
FL | 4069 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QA0000X | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | Group - Multi-Specialty |
No | 207QA0505X | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | Group - Multi-Specialty |
No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207RA0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine | Group - Multi-Specialty |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 374917700 | Medicaid | |
FL | 374917700 | Medicaid |