Provider Demographics
NPI:1851662472
Name:SEMINOLE TRIBE OF FLORIDA
Entity Type:Organization
Organization Name:SEMINOLE TRIBE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR SEMINOLE TRIBE OF F
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:954-962-2009
Mailing Address - Street 1:1120 S. FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142
Mailing Address - Country:US
Mailing Address - Phone:239-867-3400
Mailing Address - Fax:239-657-2304
Practice Address - Street 1:1120 S. FIRST STREET
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142
Practice Address - Country:US
Practice Address - Phone:239-867-3400
Practice Address - Fax:239-657-2304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEMINOLE TRIBE OF FLORIDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care