Provider Demographics
NPI:1851940035
Name:FLORIDA HOSPITAL WATERMAN INC
Entity type:Organization
Organization Name:FLORIDA HOSPITAL WATERMAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDRII
Authorized Official - Middle Name:
Authorized Official - Last Name:KORCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-524-5645
Mailing Address - Street 1:1000 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:770 W GRANADA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5179
Practice Address - Country:US
Practice Address - Phone:352-253-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA HOSPITAL WATERMAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-10
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit