Provider Demographics
NPI:1982640397
Name:COUNTY OF JACKSON OFFICE CLERK BOARD COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:COUNTY OF JACKSON OFFICE CLERK BOARD COUNTY COMMISSIONERS
Other - Org Name:JACKSON CO FIRE RESCUE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-718-0000
Mailing Address - Street 1:2864 MADISON STREET
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-4610
Mailing Address - Country:US
Mailing Address - Phone:850-718-0000
Mailing Address - Fax:850-718-0048
Practice Address - Street 1:2864 MADISON STREET
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-4610
Practice Address - Country:US
Practice Address - Phone:850-718-0000
Practice Address - Fax:850-718-0048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON COUNTY BOARD OF COUNTY COMMISSIONERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00200104OtherPALMETTO GBA -RR MEDICARE
FLA0435OtherBLUE CROSS OF FLORIDA
FL088024800Medicaid
FLA0435OtherBLUE CROSS OF FLORIDA