Provider Demographics
NPI:1538739909
Name:OCOEE REGIONAL HEALTH CORPORATION
Entity type:Organization
Organization Name:OCOEE REGIONAL HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-338-8995
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-0308
Mailing Address - Country:US
Mailing Address - Phone:423-338-8995
Mailing Address - Fax:423-338-8996
Practice Address - Street 1:964 OLD FEDERAL RD
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:TN
Practice Address - Zip Code:37362-7815
Practice Address - Country:US
Practice Address - Phone:423-338-8995
Practice Address - Fax:423-338-8996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCOEE REGIONAL HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)