Provider Demographics
NPI:1659362986
Name:COUNTY OF PUTNAM BOARD OF COMMISSIONERS
Entity Type:Organization
Organization Name:COUNTY OF PUTNAM BOARD OF COMMISSIONERS
Other - Org Name:PUTNAM COUNTY EMERGENCY RESCUE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:FMS MANAGER / DEPUTY CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LANIER
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:386-329-0892
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32178-0758
Mailing Address - Country:US
Mailing Address - Phone:386-329-0240
Mailing Address - Fax:386-326-2795
Practice Address - Street 1:410 S STATE ROAD 19
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3941
Practice Address - Country:US
Practice Address - Phone:386-329-0240
Practice Address - Fax:386-326-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL002606341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
A0374OtherBCBS OF FL
FL088145700Medicaid
406590357OtherRAILROAD MEDICARE
0823376OtherUNITED MINE WORKERS
087914000OtherBLACK LUNG
406590357OtherRAILROAD MEDICARE