Provider Demographics
NPI:1730270943
Name:CYPRESS HEALTH SYSTEMS FLORIDA INC.
Entity type:Organization
Organization Name:CYPRESS HEALTH SYSTEMS FLORIDA INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-528-2801
Mailing Address - Street 1:125 SW 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2403
Mailing Address - Country:US
Mailing Address - Phone:352-528-2801
Mailing Address - Fax:352-528-3824
Practice Address - Street 1:125 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2403
Practice Address - Country:US
Practice Address - Phone:352-528-2801
Practice Address - Fax:352-528-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL282N00000X282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72816OtherBCBS OF FL PROFESSIONAL
FL660137500Medicaid
FL332OtherBCBS OF FL
FL010114100Medicaid
FL256450500Medicaid
FL660137500Medicaid
FL100139Medicare PIN
FL103421Medicare ID - Type Unspecified
FL72816Medicare ID - Type Unspecified