Provider Demographics
NPI:1891722641
Name:FLORIDA HOSPITAL WATERMAN INC
Entity Type:Organization
Organization Name:FLORIDA HOSPITAL WATERMAN INC
Other - Org Name:ADVENTHEALTH WATERMAN SPECIAL TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-253-3153
Mailing Address - Street 1:2250 HUFFSTETLER DR STE 2506
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5264
Mailing Address - Country:US
Mailing Address - Phone:352-253-3880
Mailing Address - Fax:352-253-3883
Practice Address - Street 1:2250 HUFFSTETLER DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5264
Practice Address - Country:US
Practice Address - Phone:352-253-3880
Practice Address - Fax:352-253-3883
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA HOSPITAL WATERMAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-27
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0894443-00Medicaid