NPIMap

Organization Active NPI

Hendry County Hospital Authority

  • Medicare Defined Swing Bed Hospital Unit
  • Clewiston, FL
National Provider Identifier
1376567719
Registry record updated Nov 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
3995 Issued in FL
Legal business name
HENDRY COUNTY HOSPITAL AUTHORITY
Practice address
524 W Sagamore Ave
Clewiston, FL 33440-3514
Phone
(863) 983-9121
Fax
(863) 983-3426
NPI assigned
Jul 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2015

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

Authorized official

Name
Raymond D Williams
Title
Ceo
Phone
(863) 902-3076

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 3995 FL Primary

Addresses

Primary practice location

524 W Sagamore Ave
Clewiston, FL 33440-3514

Mailing address

524 W Sagamore Ave
Clewiston, FL 33440-3514
Phone (863) 983-9121

Other names 1

  • Hendry Regional Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220803000853 FL Part A Provider - Critical Access Hospital 8022912435 Practice locations: Clewiston, FL

Hospital certification: CCN 10Z309

Legal name
HENDRY COUNTY HOSPITAL AUTHORITY
Doing business as
HENDRY REGIONAL MEDICAL CENTER SWINGBED
Organization structure
OtherNon-profit
Enrollment address
524 W Sagamore Ave
Hendry Regional Medical Center Swingbed
Clewiston, FL 33440-3514
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Bethesda Prenatal Diag5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

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 DirectorChief Operating Officer Nov 18, 2021
W-2 Managing EmployeeChief Operating Officer Nov 18, 2021
Operational/Managerial ControlChief Operating Officer Nov 18, 2021
Jennifer Lesley Individual Corporate DirectorPatient Financial Services Direc Jul 17, 2000
W-2 Managing EmployeePatient Financial Services Direc Jul 17, 2000

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447632000000",
    "number": "1376567719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 W SAGAMORE AVE",
            "city": "CLEWISTON",
            "state": "FL",
            "postal_code": "334403514",
            "telephone_number": "863-983-9121",
            "fax_number": "863-983-3426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 W SAGAMORE AVE",
            "city": "CLEWISTON",
            "state": "FL",
            "postal_code": "334403514",
            "telephone_number": "863-983-9121",
            "fax_number": "863-983-3426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDRY COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2015-11-16",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "863-902-3076"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "FL",
            "license": "3995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hendry Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clewiston, FL

Sources for this page

Verify at the official NPI Registry.