Provider Demographics
NPI:1982775805
Name:COUNTY OF HOLMES OFFICE CLERK BOARD OF COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:COUNTY OF HOLMES OFFICE CLERK BOARD OF COUNTY COMMISSIONERS
Other - Org Name:HOLMES COUNTY EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-547-4671
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-0668
Mailing Address - Country:US
Mailing Address - Phone:850-547-4671
Mailing Address - Fax:850-547-9896
Practice Address - Street 1:949 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-6021
Practice Address - Country:US
Practice Address - Phone:850-547-4671
Practice Address - Fax:850-547-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL002596341600000X
FL33873416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0088314000Medicaid
FL0088314000Medicaid