Provider Demographics
NPI:1942576665
Name:HENDRY COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:HENDRY COUNTY HOSPITAL AUTHORITY
Other - Org Name:HENDRY REGIONAL INTERVENTIONAL PAIN THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-902-3076
Mailing Address - Street 1:530 W SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3514
Mailing Address - Country:US
Mailing Address - Phone:863-902-3006
Mailing Address - Fax:863-983-2793
Practice Address - Street 1:530 W SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3514
Practice Address - Country:US
Practice Address - Phone:863-902-3006
Practice Address - Fax:863-983-2793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDRY COUNTY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-27
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3995261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain