1649292756 NPI number — COUNTY OF OKALOOSA BOARD OF COMMISSIONERS

Table of content: (NPI 1649292756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649292756 NPI number — COUNTY OF OKALOOSA BOARD OF COMMISSIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF OKALOOSA BOARD OF COMMISSIONERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OKALOOSA EMERGENCY MED
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649292756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 116783
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-459-0664
Provider Business Mailing Address Fax Number:
305-421-0928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 COLLEGE BLVD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NICEVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32578-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-651-7150
Provider Business Practice Location Address Fax Number:
850-651-7170
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VILLANI
Authorized Official First Name:
DINO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR/OFFICER
Authorized Official Telephone Number:
850-651-7150

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 406590215 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 088193700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017422000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com