Provider Demographics
NPI:1821098492
Name:VILLAGE OF TEQUESTA FLORIDA VILLAGE OF TEQUESTA
Entity Type:Organization
Organization Name:VILLAGE OF TEQUESTA FLORIDA VILLAGE OF TEQUESTA
Other - Org Name:TEQUESTA FIRE RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-768-0550
Mailing Address - Street 1:345 TEQUESTA DR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3062
Mailing Address - Country:US
Mailing Address - Phone:561-768-0550
Mailing Address - Fax:561-768-0693
Practice Address - Street 1:357 TEQUESTA DR
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3088
Practice Address - Country:US
Practice Address - Phone:561-768-0550
Practice Address - Fax:561-768-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0025513416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA0704Medicare ID - Type UnspecifiedTEQUESTA FIRE RESCUE/AMBU