1295763712 NPI number — FLORIDA DEPARTMENT OF HEALTH

Table of content: (NPI 1295763712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295763712 NPI number — FLORIDA DEPARTMENT OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
FLORIDA DEPARTMENT OF HEALTH
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:
ESCAMBIA COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
3
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:
1295763712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1295 W FAIRFIELD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32501-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-595-6417
Provider Business Mailing Address Fax Number:
850-595-6693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1295 W FAIRFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32501-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-595-6417
Provider Business Practice Location Address Fax Number:
850-595-6693
Provider Enumeration Date:
06/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LANZA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DIRECTOR AND HEALTH OFFICER
Authorized Official Telephone Number:
850-595-6500

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 99387 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0600181 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".