Provider Demographics
NPI:1528233632
Name:FLOWER HOSPITAL
Entity type:Organization
Organization Name:FLOWER HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-843-8178
Mailing Address - Street 1:5855 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2269
Mailing Address - Country:US
Mailing Address - Phone:419-824-7264
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:5200 HARROUN RD
Practice Address - Street 2:FLOWER HOSPITAL PA
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2168
Practice Address - Country:US
Practice Address - Phone:419-824-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLOWER HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0871525Medicaid
OH3600741Medicare PIN