NPIMap

Organization Active NPI

Desoto Memorial Hospital Inc

Doing business as DeSoto Memorial Center for Family Health

  • Rural Health Clinic/Center
  • Arcadia, FL
National Provider Identifier
1639261175
Registry record updated Mar 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
4218 Issued in FL
Legal business name
DESOTO MEMORIAL HOSPITAL INC
Doing business as
DeSoto Memorial Center for Family Health
Practice address
888 N Roberts Ave
Arcadia, FL 34266-9580
Phone
(863) 494-8401
Fax
(863) 491-4328
NPI assigned
Sep 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2011

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

Authorized official

Name
Mr. Vincent A Sica
Title
Ceo
Phone
(863) 494-8403

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 4218 FL Primary

Addresses

Primary practice location

888 N Roberts Ave
Arcadia, FL 34266-9580

Mailing address

888 N Roberts Ave
Arcadia, FL 34266-9580
Phone (863) 494-8401

Other identifiers 3

IdentifierTypeStateIssuer
00746OtherFLMEDICARE
252217900MedicaidFL
660074300MedicaidFL

Other names 1

  • DeSoto Memorial Center for Family Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Desoto Memorial Hospita3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301270400000",
    "number": "1639261175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 N ROBERTS AVE",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342669580",
            "telephone_number": "863-494-8401",
            "fax_number": "863-491-4328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 N ROBERTS AVE",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342669580",
            "telephone_number": "863-494-8401",
            "fax_number": "863-491-4328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESOTO MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2011-03-28",
        "status": "A",
        "authorized_official_last_name": "SICA",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "863-494-8403",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "4218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "00746",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252217900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660074300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeSoto Memorial Center for Family Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arcadia, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.