Provider Demographics
NPI:1295872331
Name:LEVY COUNTY BOARD OF COUNTY COMMISSIONERS
Entity type:Organization
Organization Name:LEVY COUNTY BOARD OF COUNTY COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF BOARD
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-486-5218
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:FL
Mailing Address - Zip Code:32621-0448
Mailing Address - Country:US
Mailing Address - Phone:352-486-5209
Mailing Address - Fax:352-486-5401
Practice Address - Street 1:9010 NE 79TH AVE
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:FL
Practice Address - Zip Code:32621
Practice Address - Country:US
Practice Address - Phone:352-486-5209
Practice Address - Fax:352-486-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL088051500Medicaid
FLA0449Medicare ID - Type UnspecifiedAMBULANCE SERVICE