Basic Information
Provider Information | |||||||||
NPI: | 1619080322 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FLORIDA HOSPITAL ZEPHYRHILLS INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7050 GALL BLVD | ||||||||
Address2: |   | ||||||||
City: | ZEPHYRHILLS | ||||||||
State: | FL | ||||||||
PostalCode: | 335411347 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8137880411 | ||||||||
FaxNumber: | 8137836196 | ||||||||
Practice Location | |||||||||
Address1: | 7050 GALL BLVD | ||||||||
Address2: |   | ||||||||
City: | ZEPHYRHILLS | ||||||||
State: | FL | ||||||||
PostalCode: | 335411347 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8137880411 | ||||||||
FaxNumber: | 8137836196 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/16/2006 | ||||||||
LastUpdateDate: | 05/02/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SURBER | ||||||||
AuthorizedOfficialFirstName: | RANDALL | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 8137880411 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 4445 | FL | N |   | Hospital Units | Psychiatric Unit |   | 273R00000X |   |   | Y |   | Hospital Units | Psychiatric Unit |   |
ID Information
ID | Type | State | Issuer | Description | 101494000 | 01 | FL | MEDIPASS/FIRST HEALTH SVC | OTHER | FA06322890001 | 01 | FL | CIGNA BEHAVIORAL HEALTH | OTHER | 10149400 | 05 | FL |   | MEDICAID | 101494000 | 01 | FL | FLORIDA HEALTH PARTNERS/F | OTHER |