Provider Demographics
NPI:1710028410
Name:CITY OF PEMBROKE PINES
Entity Type:Organization
Organization Name:CITY OF PEMBROKE PINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION CHIEF OF RESCUE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-499-9584
Mailing Address - Street 1:9500 PINES BLVD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6258
Mailing Address - Country:US
Mailing Address - Phone:954-499-9581
Mailing Address - Fax:954-517-8432
Practice Address - Street 1:9500 PINES BLVD
Practice Address - Street 2:BLDG B
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6258
Practice Address - Country:US
Practice Address - Phone:954-499-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL085063200Medicaid
FLN7076OtherSTAY WELL HEALTH PLAN
FL590000614OtherPALMETTO GBA RAILROAD MED
FLA0444OtherBC/BS OF FLORIDA
FL590000614OtherPALMETTO GBA RAILROAD MED