Provider Demographics
NPI:1215071964
Name:CITY OF WEST PALM BEACH
Entity type:Organization
Organization Name:CITY OF WEST PALM BEACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-804-4705
Mailing Address - Street 1:PO BOX 734915
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4915
Mailing Address - Country:US
Mailing Address - Phone:561-804-4700
Mailing Address - Fax:561-804-4777
Practice Address - Street 1:500 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-804-4730
Practice Address - Fax:561-804-4777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF WEST PALM BEACH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL770276078Medicaid
FL770276978Medicaid
FL770276978Medicaid