Provider Demographics
NPI:1104821461
Name:MADISON COUNTY HOSPITAL HEALTH SYSTEMS, INC.
Entity type:Organization
Organization Name:MADISON COUNTY HOSPITAL HEALTH SYSTEMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-973-2271
Mailing Address - Street 1:224 NW CRANE AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-1400
Mailing Address - Country:US
Mailing Address - Phone:850-973-2271
Mailing Address - Fax:850-973-2818
Practice Address - Street 1:224 NW CRANE AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-1400
Practice Address - Country:US
Practice Address - Phone:850-973-2271
Practice Address - Fax:850-973-2818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4346282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060090300Medicaid
FL0101150-00Medicaid
FL110OtherBLUE CROSS
FL020053100Medicaid
FL110OtherBLUE CROSS