Basic Information
| Provider Information | |||||||||
| NPI: | 1376529743 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MORTON PLANT HOSPITAL ASSOCIATION INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MORTON PLANT HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 PINELLAS ST | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272819479 | ||||||||
| FaxNumber: | 7274618101 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PINELLAS ST | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274627000 | ||||||||
| FaxNumber: | 7274618101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KEEN | ||||||||
| AuthorizedOfficialFirstName: | BRIANT | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, REVENUE MANAGEMENT SVS | ||||||||
| AuthorizedOfficialTelephone: | 7275191672 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 4064 | FL | N | Hospital Units | Psychiatric Unit | 282N00000X | 4064 | FL | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0101583-00 | 05 | FL | MEDICAID | AM0176645 | 01 | FL | DEA | OTHER | 10D0645549 | 01 | FL | CLIA | OTHER |