Provider Demographics
NPI:1649281924
Name:CITY OF FORT LAUDERDALE
Entity type:Organization
Organization Name:CITY OF FORT LAUDERDALE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-828-6800
Mailing Address - Street 1:PO BOX 31076
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33631-3076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:528 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-1162
Practice Address - Country:US
Practice Address - Phone:954-828-6847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3234341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL590013949OtherRAILROAD PROVIDER ID
FL400063300Medicaid
FL590013949OtherRAILROAD PROVIDER ID