Provider Demographics
NPI:1518296854
Name:SEBASTIAN HOSPITAL LLC
Entity Type:Organization
Organization Name:SEBASTIAN HOSPITAL LLC
Other - Org Name:SEBASTIAN RIVER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP AND GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:239-598-3111
Mailing Address - Street 1:13695 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3230
Mailing Address - Country:US
Mailing Address - Phone:772-664-8379
Mailing Address - Fax:772-664-8677
Practice Address - Street 1:8000 RON BEATTY BLVD
Practice Address - Street 2:SUITE A1 AND A2
Practice Address - City:BAREFOOT BAY
Practice Address - State:FL
Practice Address - Zip Code:32976-7474
Practice Address - Country:US
Practice Address - Phone:772-664-8379
Practice Address - Fax:772-664-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
10021700Medicare Oscar/Certification