Provider Demographics
NPI:1003851767
Name:COUNTY OF HAMILTON
Entity Type:Organization
Organization Name:COUNTY OF HAMILTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-792-6817
Mailing Address - Street 1:207 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-6633
Mailing Address - Country:US
Mailing Address - Phone:386-792-1288
Mailing Address - Fax:386-792-6432
Practice Address - Street 1:207 1ST ST NE
Practice Address - Street 2:902 US HWY 41 NW
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052-6633
Practice Address - Country:US
Practice Address - Phone:386-792-1288
Practice Address - Fax:386-792-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0025193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL088053100Medicaid
FL=========OtherTAX I.D. NUMBER
FL088053100Medicaid