Provider Demographics
NPI:1346273455
Name:COUNTY OF BAKER
Entity Type:Organization
Organization Name:COUNTY OF BAKER
Other - Org Name:BAKER COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-259-0229
Mailing Address - Street 1:1190 W MACCLENNY AVE
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-4458
Mailing Address - Country:US
Mailing Address - Phone:904-259-0229
Mailing Address - Fax:
Practice Address - Street 1:1190 W MACCLENNY AVE
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-0958
Practice Address - Country:US
Practice Address - Phone:904-259-0229
Practice Address - Fax:904-259-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2711341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL088018300Medicaid
FL406590650OtherRAILROAD MEDICARE
FLA0492Medicare ID - Type Unspecified