Provider Demographics
NPI:1720152283
Name:OAK HILL HOSPITALIST, LLC
Entity Type:Organization
Organization Name:OAK HILL HOSPITALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPS VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-793-6004
Mailing Address - Street 1:P O BOX 281380
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1380
Mailing Address - Country:US
Mailing Address - Phone:615-372-3270
Mailing Address - Fax:866-201-4732
Practice Address - Street 1:11375 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5409
Practice Address - Country:US
Practice Address - Phone:352-597-6007
Practice Address - Fax:352-597-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGRP#278231600Medicaid
FL39010OtherBCBS FL
FLGRP#278231600Medicaid
FL39010OtherBCBS FL