Provider Demographics
NPI:1700865870
Name:COUNTY OF MADISON OFFICE CLERK BOARD COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:COUNTY OF MADISON OFFICE CLERK BOARD COUNTY COMMISSIONERS
Other - Org Name:MADISON COUNTY FIRE/RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-464-7586
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32341-0237
Mailing Address - Country:US
Mailing Address - Phone:850-973-1494
Mailing Address - Fax:850-973-4157
Practice Address - Street 1:1314 W BASE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-1416
Practice Address - Country:US
Practice Address - Phone:850-973-1494
Practice Address - Fax:850-973-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL002557341600000X
341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL088042600Medicaid
FL088042600Medicaid