Provider Demographics
NPI:1740551530
Name:SEMINOLE TRIBE OF FLORIDA
Entity type:Organization
Organization Name:SEMINOLE TRIBE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR-SEMINOLE TRIBE OF F
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:954-962-2009
Mailing Address - Street 1:30851 BUFFALO JIM LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440
Mailing Address - Country:US
Mailing Address - Phone:863-983-5151
Mailing Address - Fax:863-983-7875
Practice Address - Street 1:30851 BUFFALO JIM LOOP ROAD
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440
Practice Address - Country:US
Practice Address - Phone:863-983-5151
Practice Address - Fax:863-983-7875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEMINOLE TRIBE OF FLORIDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care