1346495652 NPI number — CITY OF FERNANDINA BEACH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346495652 NPI number — CITY OF FERNANDINA BEACH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF FERNANDINA BEACH
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:
1346495652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2829
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32056-2829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-310-3152
Provider Business Mailing Address Fax Number:
904-310-3453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 S. 10TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERNANDINA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32034-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-310-3152
Provider Business Practice Location Address Fax Number:
904-310-3453
Provider Enumeration Date:
12/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MURALLO
Authorized Official First Name:
RUFINO
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY FIRE CHIEF/EMS CHIEF
Authorized Official Telephone Number:
904-310-3152

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00710332 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: A0773 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 001305000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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