Provider Demographics
NPI:1679568943
Name:BOARD OF COUNTY COMMISSIONERS GULF COUNTY
Entity Type:Organization
Organization Name:BOARD OF COUNTY COMMISSIONERS GULF COUNTY
Other - Org Name:GULF COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLERK OF COURT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-229-6112
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-0910
Mailing Address - Country:US
Mailing Address - Phone:850-229-8002
Mailing Address - Fax:850-227-3862
Practice Address - Street 1:1000 CECIL G COSTIN SR BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1653
Practice Address - Country:US
Practice Address - Phone:850-229-6112
Practice Address - Fax:850-229-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0024293416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL400025101Medicaid
FL400025101Medicaid
FL400025101Medicaid