Provider Demographics
NPI:1851346787
Name:FISHERMEN'S HOSPITAL, INC.
Entity Type:Organization
Organization Name:FISHERMEN'S HOSPITAL, INC.
Other - Org Name:FISHERMEN'S COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEFTWICH
Authorized Official - Suffix:
Authorized Official - Credentials:DBA, FACHE
Authorized Official - Phone:305-289-6401
Mailing Address - Street 1:3301 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2329
Mailing Address - Country:US
Mailing Address - Phone:305-289-6401
Mailing Address - Fax:305-743-3962
Practice Address - Street 1:3301 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2329
Practice Address - Country:US
Practice Address - Phone:305-289-6401
Practice Address - Fax:305-743-3962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4389282N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010120600Medicaid
FL175OtherBLUE CROSS
FL175OtherBLUE CROSS
101312Medicare Oscar/Certification