Provider Demographics
NPI:1689693293
Name:OCOEE HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:OCOEE HOSPITAL CORPORATION
Other - Org Name:BRADLEY MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP, GROUP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-373-9600
Mailing Address - Street 1:PO BOX 403914
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2305 CHAMBLISS AVE NW
Practice Address - Street 2:POB 3060
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3847
Practice Address - Country:US
Practice Address - Phone:423-559-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000031282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4400024Medicaid
4111694OtherBCBS
SC241517Medicaid
GA00000228AMedicaid
OH0200937Medicaid
KY01621945Medicaid
A3731101OtherJOHN DEERE
TN4111694Medicaid
440024OtherCARITEN
NC4400024Medicaid
=========OtherCHAMPUS
A3731101OtherJOHN DEERE
=========OtherCIGNA
GA00000228AMedicaid