Provider Demographics
NPI:1154462703
Name:POLK COUNTY BOARD OF COUNTY COMMISSIONERS (POLK COUNTY BOCC)
Entity Type:Organization
Organization Name:POLK COUNTY BOARD OF COUNTY COMMISSIONERS (POLK COUNTY BOCC)
Other - Org Name:THE ROHR HOME PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL (SAM)
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-534-6049
Mailing Address - Street 1:2135 MARSHALL EDWARDS DR
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6757
Mailing Address - Country:US
Mailing Address - Phone:863-519-7579
Mailing Address - Fax:863-519-4783
Practice Address - Street 1:2120 MARSHALL EDWARDS DR
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-6731
Practice Address - Country:US
Practice Address - Phone:863-519-7579
Practice Address - Fax:863-519-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010168101Medicaid
FL010168101Medicaid