Provider Demographics
NPI:1952448383
Name:COUNTY OF WAKULLA BOARD OF COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:COUNTY OF WAKULLA BOARD OF COUNTY COMMISSIONERS
Other - Org Name:WAKULLA COUNTY FIRE RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC SAFETY DIRECTOR/FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-745-8698
Mailing Address - Street 1:318 TRICE LN
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-2261
Mailing Address - Country:US
Mailing Address - Phone:850-745-8698
Mailing Address - Fax:850-926-4982
Practice Address - Street 1:318 TRICE LANE
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-2261
Practice Address - Country:US
Practice Address - Phone:850-745-8698
Practice Address - Fax:850-926-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0881058Medicaid
FL590008322Medicare PIN
FL0881058Medicaid