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Organization
HAWTHORNE MEDICAL CENTER, INC.
Active
Organization
HAWTHORNE MEDICAL CENTER, INC.
Active
Other names
Hawthorne Medical Center, PA
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA O MCCULLOUGH RN COHN-S (PRESIDENT/OWNER)
(352) 481-2400
Entity
Organization
Contact information
Practice address
21815 S.E .71ST AVENUE, HAWTHORNE, FL 32640-3974
(352) 481-2400
(352) 481-2777
Mailing address
21815 S.E .71ST AVENUE, HAWTHORNE, FL 32640-3974
(352) 481-2400
(352) 481-2777
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
HCC8421
FL
207Q00000X
Family Medicine Physician
ME63062
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18622
BLUE CROSS BLUE SHIELD
FL
05
—
37209S100
—
FL
01
—
45696
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/02/2006
Last updated
07/06/2009
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