Provider Demographics
NPI:1245442169
Name:OCOEE REGIONAL HEALTH CORPORATION
Entity type:Organization
Organization Name:OCOEE REGIONAL HEALTH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-338-8995
Mailing Address - Street 1:1420 FRITZ ST SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-6009
Mailing Address - Country:US
Mailing Address - Phone:423-478-1970
Mailing Address - Fax:423-614-5270
Practice Address - Street 1:2020 WESTLAND DR SW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-8163
Practice Address - Country:US
Practice Address - Phone:423-338-8995
Practice Address - Fax:423-614-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3379622Medicare PIN
TN441889Medicare Oscar/Certification