Provider Demographics
NPI:1396880654
Name:COUNTY OF JEFFERSON OFFICE OF CLERK CIRCUIT COURT
Entity type:Organization
Organization Name:COUNTY OF JEFFERSON OFFICE OF CLERK CIRCUIT COURT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-342-0178
Mailing Address - Street 1:COUNTY COURTHOUSE
Mailing Address - Street 2:ROOM 10
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-1972
Mailing Address - Country:US
Mailing Address - Phone:850-342-0180
Mailing Address - Fax:850-342-0181
Practice Address - Street 1:1456 S. JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-0000
Practice Address - Country:US
Practice Address - Phone:850-342-0180
Practice Address - Fax:850-342-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL088061200Medicaid
FL088061200Medicaid