Provider Demographics
NPI:1255331187
Name:MARTIN COUNTY FLORIDA BOARD OF COMMISSIONERS
Entity Type:Organization
Organization Name:MARTIN COUNTY FLORIDA BOARD OF COMMISSIONERS
Other - Org Name:MARTIN COUNTY FIRE RESCUE
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-463-6277
Mailing Address - Street 1:3485 SE WILLOUGHBY BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5060
Mailing Address - Country:US
Mailing Address - Phone:772-463-7277
Mailing Address - Fax:772-419-4544
Practice Address - Street 1:800 SE MONTEREY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4507
Practice Address - Country:US
Practice Address - Phone:772-288-5710
Practice Address - Fax:772-288-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL001740341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL590007709OtherMEDICARE METRAHEALTH
NC1006911OtherMEDICAID/NC
PA227254OtherBC CAPITAL/778995
GA636574609AOtherGEORGIA MCD
SCQAB159OtherMEDICAID SC
FL083903500Medicaid
NC1006911OtherNORTH CAROLINA MCD
FL229946600OtherUS DEPARTMENT OF LABOR
CT7400743OtherCONNECTICARE
GA636574609AOtherGEORGIA MCD