MEDICARE: COUNTY OF HERNANDO BOARD OF COUNTY COMMISSIONERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	2502	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	159292100	OTHER	FL	US DEPT OF LABOR
3	A0726	OTHER	FL	BLUE CROSS PROVIDER #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326044793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF HERNANDO BOARD OF COUNTY COMMISSIONERS

Provider Business Mailing Address
First Line	:	15470 FLIGHT PATH DR
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-6823
Country	:	US
Telephone Number	:	352-540-4353
Fax Number	:	352-540-4355

Provider Business Practice Location Address
First Line	:	60 VETERANS AVE
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34601
Country	:	US
Telephone Number	:	352-540-4353
Fax Number	:	352-540-4355

Authorized Official
Title or Position	:	CHIEF
Name	:	MIKE NICKERSON
Credential	:
Telephone Number	:	352-540-4353

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	03/24/2021

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