Provider Demographics
NPI:1003896077
Name:COUNTY OF DESOTO BOARD COUNTY COMMISSIONERS
Entity type:Organization
Organization Name:COUNTY OF DESOTO BOARD COUNTY COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:863-993-4842
Mailing Address - Street 1:1985 SE CARLSTROM FIELD RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-7748
Mailing Address - Country:US
Mailing Address - Phone:863-993-4842
Mailing Address - Fax:863-993-4844
Practice Address - Street 1:1985 SE CARLSTROM FIELD RD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-7748
Practice Address - Country:US
Practice Address - Phone:863-993-4842
Practice Address - Fax:863-993-4844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF DESOTO BOARD COUNTY COMMISSIONERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-18
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL002495341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA0403Medicare ID - Type Unspecified