MEDICARE: FLORIDA DEPARTMENT OF HEALTH

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	251K00000X	Public Health or Welfare Agency	PH6758	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

General Provider Information

NPI Number	:	1689875148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	2421 SW 6TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2613
Country	:	US
Telephone Number	:	954-467-4877
Fax Number	:	954-467-4878

Provider Business Practice Location Address
First Line	:	2421 SW 6TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2613
Country	:	US
Telephone Number	:	954-467-4877
Fax Number	:	954-467-4878

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	MICHAEL R EHREN
Credential	:	RPH
Telephone Number	:	954-467-4848

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	10/14/2024

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