Basic Information
| Provider Information | |||||||||
| NPI: | 1437135811 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MORTON PLANT HOSPITAL ASSOCIATION INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MORTON PLANT NORTH BAY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346521971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272819479 | ||||||||
| FaxNumber: | 7278488762 | ||||||||
| Practice Location | |||||||||
| Address1: | 6600 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346521971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278438468 | ||||||||
| FaxNumber: | 7278488762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TREMONTI | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO, BAYCARE HOSPITAL DIVISION | ||||||||
| AuthorizedOfficialTelephone: | 7274627176 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | FL | N | Hospital Units | Psychiatric Unit | 282N00000X | 4216 | FL | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0101508-00 | 05 | FL | MEDICAID | 10D0297904 | 01 | FL | CLIA | OTHER | AT2871209 | 01 | FL | DEA | OTHER |