Provider Demographics
NPI:1932149531
Name:FLORIDA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:CALHOUN COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR (RN, MSN, MBA/HCM)
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-674-5645
Mailing Address - Street 1:19611 STATE ROAD 20 WEST
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-3917
Mailing Address - Country:US
Mailing Address - Phone:850-674-5645
Mailing Address - Fax:850-674-5420
Practice Address - Street 1:19611 STATE ROAD 20 WEST
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-3917
Practice Address - Country:US
Practice Address - Phone:850-674-5645
Practice Address - Fax:850-674-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027917091Medicaid
FL029717000Medicaid
FL027917004Medicaid
FL027917002Medicaid
FL027917010Medicaid
FL027917011Medicaid
FL027917007Medicaid
FL027917003Medicaid
FL027917030Medicaid
K7707OtherMEDICARE SENDER NUMBER
FL027917030Medicaid