Provider Demographics
NPI:1548242571
Name:CLAY COUNTY BOARD OF COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:CLAY COUNTY BOARD OF COUNTY COMMISSIONERS
Other - Org Name:CLAY COUNTY FIRE RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-541-2778
Mailing Address - Street 1:PO BOX 947668
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7668
Mailing Address - Country:US
Mailing Address - Phone:904-529-5805
Mailing Address - Fax:904-284-8015
Practice Address - Street 1:2519 STATE ROAD 16 W
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-4819
Practice Address - Country:US
Practice Address - Phone:904-529-5805
Practice Address - Fax:904-284-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL341600000X341600000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
0081031200OtherFEDERAL BLACK LUNG
162909000OtherUS DEPT OF LABOR W/C
FL088103100Medicaid
A0042Medicare UPIN
162909000OtherUS DEPT OF LABOR W/C
0081031200OtherFEDERAL BLACK LUNG