NPIMap

Organization Active NPI

Hendry County Hospital Authority

Doing business as Hendry Regional Cardiology & Vein Center

  • Specialist
  • Clewiston, FL
National Provider Identifier
1336165935
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
3995 Issued in FL
Legal business name
HENDRY COUNTY HOSPITAL AUTHORITY
Doing business as
Hendry Regional Cardiology & Vein Center
Hendry Regional Cardiovascular and Vein Center
Hendry Regional Specialty Group
Practice address
540 W Sagamore Ave
Clewiston, FL 33440-3514
Phone
(863) 983-5023
Fax
(863) 983-2793
NPI assigned
Jul 15, 2006
Last updated
Sep 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Michael Theroux
Title
Coo
Phone
(863) 902-3051

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 3995 FL Primary

Addresses

Primary practice location

540 W Sagamore Ave
Clewiston, FL 33440-3514

Mailing address

540 W Sagamore Ave
Clewiston, FL 33440-3514
Phone (863) 983-5023

Other names 3

  • Hendry Regional Cardiology & Vein Center Doing business as
  • Hendry Regional Cardiovascular and Vein Center Doing business as
  • Hendry Regional Specialty Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031126000106 FL Part B Supplier - Clinic/Group Practice 8022912435 Receives reassigned benefits from 33 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clewiston, FL; Labelle, FL
O20080611000276 FL Part A Provider - Rural Health Clinic 8022912435 1 other NPI on this enrollment
Practice locations: Clewiston, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336165935. Details of each certification follow.

Rural health clinic certification: CCN 103422

Legal name
HENDRY COUNTY HOSPITAL AUTHORITY
Doing business as
DR JAMES D FORBES FAMILY CARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 1997
Last certification
Dec 15, 2021
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
500 W Sagamore Ave
Clewiston, FL 33440-3514

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

500 W Sagamore Ave
Ste A
Clewiston, FL 33440

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David Theroux Individual Corporate OfficerChief Operating Officer Aug 27, 2021
W-2 Managing EmployeeChief Operating Officer Aug 27, 2021
Jennifer Lesley Individual Corporate DirectorPatient Financial Services Director Aug 27, 2021
W-2 Managing EmployeePatient Financial Services Director Aug 27, 2021

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759104000000",
    "number": "1336165935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 W SAGAMORE AVE",
            "city": "CLEWISTON",
            "state": "FL",
            "postal_code": "334403514",
            "telephone_number": "863-983-5023",
            "fax_number": "863-983-2793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 W SAGAMORE AVE",
            "city": "CLEWISTON",
            "state": "FL",
            "postal_code": "334403514",
            "telephone_number": "863-983-5023",
            "fax_number": "863-983-2793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDRY COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A",
        "authorized_official_last_name": "THEROUX",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "863-902-3051"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "3995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hendry Regional Cardiology & Vein Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hendry Regional Cardiovascular and Vein Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hendry Regional Specialty Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clewiston, FL

Sources for this page

Verify at the official NPI Registry.