Organization
FAWCETT MEMORIAL HOSPITAL, INC.
Active
Other names
HCA Florida Fawcett Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
RICK SCHRADER (CFO)
(941) 629-1181
Entity
Organization
Contact information
Practice address
21298 OLEAN BLVD, PORT CHARLOTTE, FL 33952-6705
(941) 629-1181
(941) 627-6142
Mailing address
21298 OLEAN BLVD, PORT CHARLOTTE, FL 33952-6705
(941) 629-1181
(941) 627-6142
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
—
—
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000035953
HUMANA
FL
05
—
000616569X
—
GA
01
—
0007175
AETNA
—
05
—
011746300
—
FL
05
—
01608460
—
NY
01
—
032064700
BLACK LUNG
—
05
—
0968672
—
OH
05
—
11643B
—
SC
01
—
20320
WELLCARE
GA
01
—
20320
WELLCARE/STAYWELL
—
05
—
304862874
—
MI
01
—
571
BLUE CROSS
FL
05
—
HLFL0102
—
MI
Enumeration date
05/22/2006
Last updated
11/07/2025
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