Provider Demographics
NPI:1407828189
Name:FLORIDA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:GULF COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER/ADMINISTRAT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:850-227-1276
Mailing Address - Street 1:2475 GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-5265
Mailing Address - Country:US
Mailing Address - Phone:850-227-1276
Mailing Address - Fax:850-227-1794
Practice Address - Street 1:2475 GARRISON AVE
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-5265
Practice Address - Country:US
Practice Address - Phone:850-227-1276
Practice Address - Fax:850-227-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027933100Medicaid
FL027933101Medicaid
FL027933102Medicaid
FL027933105Medicaid
FL027933110Medicaid
FL027933111Medicaid
FL027933130Medicaid
FL027933103Medicaid
FL027933104Medicaid
FL027933109Medicaid
FL027933115Medicaid
FL027933117Medicaid
FL027933119Medicaid
FL77676Medicare PIN
FL027933119Medicaid