Provider Demographics
NPI:1396746103
Name:BIG BEND HOSPICE, INC.
Entity type:Organization
Organization Name:BIG BEND HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:WERTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:850-878-5310
Mailing Address - Street 1:1723 MAHAN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5428
Mailing Address - Country:US
Mailing Address - Phone:850-878-5310
Mailing Address - Fax:850-309-1638
Practice Address - Street 1:1723 MAHAN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5428
Practice Address - Country:US
Practice Address - Phone:850-878-5310
Practice Address - Fax:850-309-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5002096251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL087524400Medicaid
FL087524401Medicaid
FLU15OtherBLUE CROSS/BLUE SHIELD
FL087524401Medicaid