1164422747 NPI number — BOARD OF COUNTY COMMISSIONERS OF NASSAU COUNTY

Table of content: (NPI 1164422747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164422747 NPI number — BOARD OF COUNTY COMMISSIONERS OF NASSAU COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF COUNTY COMMISSIONERS OF NASSAU COUNTY
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:
Provider Other Organization Name Type Code:
6
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:
1164422747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96135 NASSAU PL STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YULEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32097-8635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-530-6030
Provider Business Mailing Address Fax Number:
904-530-6903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96160 NASSAU PL STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YULEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32097-8626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-530-6600
Provider Business Practice Location Address Fax Number:
904-321-5748
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
POPE
Authorized Official First Name:
TACO
Authorized Official Middle Name:
Authorized Official Title or Position:
COUNTY MANAGER
Authorized Official Telephone Number:
904-530-6010

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 3712 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 159897600 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N413568 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000674858A . This is a "MEDICAID GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 406590904 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 088086800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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