Provider Demographics
NPI:1437262565
Name:COUNTY OF BROWARD OFFICE OF THE SHERIFF
Entity Type:Organization
Organization Name:COUNTY OF BROWARD OFFICE OF THE SHERIFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FIRE RESCUE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-831-8291
Mailing Address - Street 1:PO BOX 919068
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2601 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1308
Practice Address - Country:US
Practice Address - Phone:954-831-8291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3215341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA0692OtherPART B MEDICARE #
FL400042100Medicaid
590011345OtherRAILROAD PROVIDER ID