Basic Information
| Provider Information | |||||||||
| NPI: | 1992973499 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20370 NE BURNS AVE | ||||||||
| Address2: | |||||||||
| City: | BLOUNTSTOWN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324241045 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 20370 NE BURNS AVE | ||||||||
| Address2: | |||||||||
| City: | BLOUNTSTOWN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324241045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506745411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2008 | ||||||||
| LastUpdateDate: | 01/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | HILL | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8506745411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 2981 | FL | Y | Transportation Services | Ambulance | Land Transport |
No ID Information.