Provider Demographics
NPI:1780647529
Name:FLORIDA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:WASHINGTON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BS,MPH
Authorized Official - Phone:850-638-6240
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-0648
Mailing Address - Country:US
Mailing Address - Phone:850-638-6240
Mailing Address - Fax:850-638-6244
Practice Address - Street 1:1338 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1846
Practice Address - Country:US
Practice Address - Phone:850-638-6240
Practice Address - Fax:850-638-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0279773-00Medicaid
FL77397OtherBLUE CROSS/BLUE SHIELD
FL77397Medicare PIN