Basic Information
| Provider Information | |||||||||
| NPI: | 1558734095 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARTOW REGIONAL MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2985 DREW ST | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337593012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272819479 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 OSPREY BLVD | ||||||||
| Address2: | |||||||||
| City: | BARTOW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338303308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8635338111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2015 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | WATERS | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP | ||||||||
| AuthorizedOfficialTelephone: | 7277549222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 12041300 | 05 | FL | MEDICAID |