Provider Demographics
NPI:1194821595
Name:BREVARD COUNTY BOARD OF COUNTY COMMISSIONER
Entity Type:Organization
Organization Name:BREVARD COUNTY BOARD OF COUNTY COMMISSIONER
Other - Org Name:BREVARD COUNTY FIRE RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:VOLTAIRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:321-633-2056
Mailing Address - Street 1:PO BOX 915189
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-5189
Mailing Address - Country:US
Mailing Address - Phone:321-633-2056
Mailing Address - Fax:321-633-2057
Practice Address - Street 1:1040 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2498
Practice Address - Country:US
Practice Address - Phone:321-633-2056
Practice Address - Fax:321-633-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3317341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL088137600Medicaid
FL590008172OtherRAILROAD MEDICARE
FL088137600Medicaid