Provider Demographics
NPI:1518126499
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:CFO SVP
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:WILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-771-8000
Mailing Address - Street 1:4725 N FEDERAL HWY
Mailing Address - Street 2:PATHOLOGY DEPARTMENT
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4603
Mailing Address - Country:US
Mailing Address - Phone:954-771-8000
Mailing Address - Fax:
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-771-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY CROSS HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4069207U00000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374917700Medicaid
FL24570EMedicare PIN