1528733623 NPI number — CITY OF COCONUT CREEK

Table of content: (NPI 1528733623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528733623 NPI number — CITY OF COCONUT CREEK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF COCONUT CREEK
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:
COCONUT CREEK FIRE RESCUE
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:
1528733623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100314
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29202-3314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-226-1012
Provider Business Mailing Address Fax Number:
833-953-0588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4555 SOL PRESS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCONUT CREEK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33073-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-973-6706
Provider Business Practice Location Address Fax Number:
954-420-5855
Provider Enumeration Date:
08/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BLIZZARD
Authorized Official First Name:
BRAIN
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM FIRE CHIEF
Authorized Official Telephone Number:
954-543-7105

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: 112679700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P02634113 . This is a "RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 112679700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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