Provider Demographics
NPI:1033229497
Name:SEMINOLE TRIBE OF FLORIDA
Entity Type:Organization
Organization Name:SEMINOLE TRIBE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-966-6300
Mailing Address - Street 1:25640 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1256
Mailing Address - Country:US
Mailing Address - Phone:305-459-0667
Mailing Address - Fax:305-428-5380
Practice Address - Street 1:HC 61 BOX 49
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-9502
Practice Address - Country:US
Practice Address - Phone:863-983-2150
Practice Address - Fax:863-983-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
FL34673416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance