Provider Demographics
NPI:1639103005
Name:COUNTY OF HENDRY OFFICE OF CLERK BOARD COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:COUNTY OF HENDRY OFFICE OF CLERK BOARD COUNTY COMMISSIONERS
Other - Org Name:HENDRY COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PUBLIC SAFETY
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BENGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-674-5411
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33975-0038
Mailing Address - Country:US
Mailing Address - Phone:863-674-5411
Mailing Address - Fax:863-612-0723
Practice Address - Street 1:4425 W. STATE ROAD 80
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935
Practice Address - Country:US
Practice Address - Phone:863-674-5411
Practice Address - Fax:863-612-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3240341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084839500Medicaid
FLA0570Medicare ID - Type Unspecified