Provider Demographics
NPI:1225054802
Name:COUNTY OF GILCHRIST BOARD OF CO COMMISSIONERS
Entity Type:Organization
Organization Name:COUNTY OF GILCHRIST BOARD OF CO COMMISSIONERS
Other - Org Name:GILCHRIST COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-935-5400
Mailing Address - Street 1:3250 N US HIGHWAY 129
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:FL
Mailing Address - Zip Code:32619-3319
Mailing Address - Country:US
Mailing Address - Phone:386-935-5400
Mailing Address - Fax:386-935-0294
Practice Address - Street 1:3250 N US HIGHWAY 129
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:FL
Practice Address - Zip Code:32619-3319
Practice Address - Country:US
Practice Address - Phone:386-935-5400
Practice Address - Fax:386-935-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37763416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL089871600Medicaid
FLA0483Medicare PIN