Provider Demographics
NPI:1538468269
Name:OPEN ARMS MEDICAL CENTER AT
Entity Type:Organization
Organization Name:OPEN ARMS MEDICAL CENTER AT
Other - Org Name:OPEN ARMS MEDICAL CENTER AT HAWTHORNE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:352-481-5700
Mailing Address - Street 1:6435 SE HWY 301
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640
Mailing Address - Country:US
Mailing Address - Phone:352-481-5700
Mailing Address - Fax:352-481-5750
Practice Address - Street 1:6435 SE US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640-7309
Practice Address - Country:US
Practice Address - Phone:352-481-5700
Practice Address - Fax:352-481-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFC224AMedicare PIN