Provider Demographics
NPI:1356348312
Name:CITY OF MIRAMAR
Entity type:Organization
Organization Name:CITY OF MIRAMAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIVISION CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-602-4873
Mailing Address - Street 1:PO BOX 947249
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7249
Mailing Address - Country:US
Mailing Address - Phone:954-602-4802
Mailing Address - Fax:954-430-5313
Practice Address - Street 1:14801 SW 27TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4100
Practice Address - Country:US
Practice Address - Phone:954-602-4802
Practice Address - Fax:954-430-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
FL33613416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL590007739OtherRAILROAD PROVIDER ID
FLA0457OtherPART B MEDICARE #
FL088070100Medicaid