Organization
PUTNAM COMMUNITY MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD J. BIVACCA (PRESIDENT)
(615) 920-7000
Entity
Organization
Contact information
Practice address
611 ZEAGLER DR, PALATKA, FL 32177-3810
(386) 328-5711
(386) 325-8178
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-4536
(615) 920-7000
(615) 920-8913
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
Other
Enumeration date
01/26/2007
Last updated
07/28/2014
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