Provider Demographics
NPI:1891880605
Name:CITY OF KISSIMMEE
Entity Type:Organization
Organization Name:CITY OF KISSIMMEE
Other - Org Name:KISSIMMEE FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION DEPUTY CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-518-2222
Mailing Address - Street 1:PO BOX 917456
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7456
Mailing Address - Country:US
Mailing Address - Phone:407-518-2222
Mailing Address - Fax:
Practice Address - Street 1:101 CHURCH ST STE 200
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5054
Practice Address - Country:US
Practice Address - Phone:407-518-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3214341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084438100Medicaid
FL590007580OtherRAILROAD MEDICARE
FL590007580OtherRAILROAD MEDICARE