NPIMap

Organization Active NPI

Hendry County Hospital Authority

Doing business as Hendry Regional Convenient Care Center

  • Rural Health Clinic/Center
  • Labelle, FL
National Provider Identifier
1588859623
Registry record updated Sep 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HENDRY COUNTY HOSPITAL AUTHORITY
Doing business as
Hendry Regional Convenient Care Center
Practice address
450 S Main St
Suite 1
Labelle, FL 33935-4629
Phone
(863) 675-2356
Fax
(863) 675-2407
NPI assigned
Sep 12, 2007
Last updated
Sep 12, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2007

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

Authorized official

Name
Mr. Craig Cudworth
Title
Ceo
Phone
(863) 902-3076

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

450 S Main St
Suite 1
Labelle, FL 33935-4629

Mailing address

450 S Main St
Suite 1
Labelle, FL 33935-4629
Phone (863) 675-2356

Other names 1

  • Hendry Regional Convenient Care Center 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
O20080305000479 FL Part A Provider - Rural Health Clinic 8022912435 Practice locations: Labelle, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588859623. Details of each certification follow.

Rural health clinic certification: CCN 103445

Legal name
HENDRY COUNTY HOSPITAL AUTHORITY
Doing business as
HENDRY REGIONAL CONVENIENT CARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 9, 2008
Last certification
Jan 10, 2019
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
450 S Main St
Ste 1
Labelle, FL 33935-4629
Related CCNs
101309

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).

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1075559Hendry Regional Convenient Care Center450 S Main St Ste 2, Labelle, FL 33935Certificate of waiverOct 22, 2027

National Provider Directory

National Provider Directory

Locations

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

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 Oct 13, 2021
W-2 Managing EmployeeChief Operating Officer Oct 13, 2021
Operational/Managerial ControlChief Operating Officer Nov 18, 2021
Jennifer Lesley Individual Corporate DirectorPatient Financial Services Director Jul 26, 2021
W-2 Managing EmployeePatient Financial Services Director Jul 26, 2021

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189555200000",
    "number": "1588859623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 S MAIN ST",
            "address_2": "SUITE 1",
            "city": "LABELLE",
            "state": "FL",
            "postal_code": "339354629",
            "telephone_number": "863-675-2356",
            "fax_number": "863-675-2407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S MAIN ST",
            "address_2": "SUITE 1",
            "city": "LABELLE",
            "state": "FL",
            "postal_code": "339354629",
            "telephone_number": "863-675-2356",
            "fax_number": "863-675-2407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDRY COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2007-09-12",
        "status": "A",
        "authorized_official_last_name": "CUDWORTH",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "863-902-3076",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hendry Regional Convenient Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Labelle, FL

Sources for this page

Verify at the official NPI Registry.