Provider Demographics
NPI:1912905829
Name:ISLAMORADA VILLAGE OF ISLANDS A FLORIDA MUNICIPALITY
Entity Type:Organization
Organization Name:ISLAMORADA VILLAGE OF ISLANDS A FLORIDA MUNICIPALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:305-664-6490
Mailing Address - Street 1:420 WALMART WAY
Mailing Address - Street 2:PMB 510
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0818
Mailing Address - Country:US
Mailing Address - Phone:877-288-8561
Mailing Address - Fax:866-889-1258
Practice Address - Street 1:86800 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:ISLAMORADA
Practice Address - State:FL
Practice Address - Zip Code:33036-3162
Practice Address - Country:US
Practice Address - Phone:305-664-6490
Practice Address - Fax:305-852-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLALS4406341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL400060900Medicaid
FL400060900Medicaid