Provider Demographics
NPI:1083818298
Name:TOWN OF LONGBOAT KEY INC
Entity Type:Organization
Organization Name:TOWN OF LONGBOAT KEY INC
Other - Org Name:LONGBOAT KEY FIRE RESCUE
Other - Org Type:Other Name
Authorized Official - Title/Position:TOWN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-316-1999
Mailing Address - Street 1:501 BAY ISLES RD
Mailing Address - Street 2:
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-3142
Mailing Address - Country:US
Mailing Address - Phone:941-316-1999
Mailing Address - Fax:
Practice Address - Street 1:5490 GULF OF MEXICO DR
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-1902
Practice Address - Country:US
Practice Address - Phone:941-316-1944
Practice Address - Fax:941-316-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA0593Medicare ID - Type UnspecifiedAMBULANCE PROVIDER