Provider Demographics
NPI:1649292756
Name:COUNTY OF OKALOOSA BOARD OF COMMISSIONERS
Entity type:Organization
Organization Name:COUNTY OF OKALOOSA BOARD OF COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DINO
Authorized Official - Middle Name:J
Authorized Official - Last Name:VILLANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-651-7150
Mailing Address - Street 1:PO BOX 116783
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368
Mailing Address - Country:US
Mailing Address - Phone:305-459-0664
Mailing Address - Fax:305-421-0928
Practice Address - Street 1:90 COLLEGE BLVD E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1343
Practice Address - Country:US
Practice Address - Phone:850-651-7150
Practice Address - Fax:850-651-7170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
406590215OtherRR MEDICARE
FL088193700Medicaid
FL088193700Medicaid