Provider Demographics
NPI:1376511915
Name:FLORIDA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:TAYLOR COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:TULLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-584-5087
Mailing Address - Street 1:1215 N PEACOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2117
Mailing Address - Country:US
Mailing Address - Phone:850-584-5087
Mailing Address - Fax:850-584-8653
Practice Address - Street 1:1215 N PEACOCK AVE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2117
Practice Address - Country:US
Practice Address - Phone:850-584-5087
Practice Address - Fax:850-584-8653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027972201Medicaid
FL027972291Medicaid
FL027972207Medicaid
FL027972230Medicaid
FL027972201Medicaid