Provider Demographics
NPI:1265645204
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:BILL
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:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37367-0976
Mailing Address - Country:US
Mailing Address - Phone:423-447-6287
Mailing Address - Fax:423-447-6315
Practice Address - Street 1:3625 US 127
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37367
Practice Address - Country:US
Practice Address - Phone:423-447-6287
Practice Address - Fax:423-447-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
3379622Medicare PIN
TN441866Medicare Oscar/Certification