Provider Demographics
NPI:1073693693
Name:SEMINOLE COUNTY COMMISIONER OF ROADS AND REVENUES
Entity Type:Organization
Organization Name:SEMINOLE COUNTY COMMISIONER OF ROADS AND REVENUES
Other - Org Name:SEMINOLE COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-524-5816
Mailing Address - Street 1:200 S KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-1590
Mailing Address - Country:US
Mailing Address - Phone:229-524-5816
Mailing Address - Fax:229-524-2537
Practice Address - Street 1:629 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1597
Practice Address - Country:US
Practice Address - Phone:229-524-5816
Practice Address - Fax:229-524-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA125-02341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000002967AMedicaid
GA85041059AAMedicare ID - Type Unspecified