Provider Demographics
NPI:1750610325
Name:SEMINOLE TRIBE OF FLORIDA HEALTH DEPARTMENT
Entity type:Organization
Organization Name:SEMINOLE TRIBE OF FLORIDA HEALTH DEPARTMENT
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 1:17201 CIVIC ST NE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-2729
Mailing Address - Country:US
Mailing Address - Phone:863-763-0271
Mailing Address - Fax:863-763-9698
Practice Address - Street 1:17201 CIVIC ST. NE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-2729
Practice Address - Country:US
Practice Address - Phone:863-763-0271
Practice Address - Fax:863-763-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1182592261QP0904X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal