NPIMap

Organization Active NPI

Putnam Community Medical Center LLC

Doing business as Putnam Community Medical Center

  • Rural Acute Care Hospital
  • Palatka, FL
National Provider Identifier
1760599286
Registry record updated Apr 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
4350 Issued in FL
Legal business name
PUTNAM COMMUNITY MEDICAL CENTER LLC
Doing business as
Putnam Community Medical Center
Practice address
611 Zeagler Dr
Palatka, FL 32177-3810
Phone
(386) 328-5711
Fax
(386) 325-8178
NPI assigned
Aug 23, 2006
Last updated
Apr 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2014

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

Authorized official

Name
Donald J. Bivacca
Title
President
Phone
(615) 920-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X 4350 FL Primary

Addresses

Primary practice location

611 Zeagler Dr
Palatka, FL 32177-3810

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-4536
Phone (615) 920-7000

Other identifiers 1

IdentifierTypeStateIssuer
011351400MedicaidFL

Other names 1

  • Putnam Community Medical Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Putnam Community Medical Center of North Florida LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397001600000",
    "number": "1760599286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274536",
            "telephone_number": "615-920-7000",
            "fax_number": "615-920-8913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 ZEAGLER DR",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321773810",
            "telephone_number": "386-328-5711",
            "fax_number": "386-325-8178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUTNAM COMMUNITY MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2014-04-09",
        "status": "A",
        "authorized_official_last_name": "BIVACCA",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "FL",
            "license": "4350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011351400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Putnam Community Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palatka, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; 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.