MEDICARE: CITY OF HOLLYWOOD

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	341600000X	Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	590098217	OTHER	RAILROAD PROVIDER ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962409912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF HOLLYWOOD

Provider Business Mailing Address
First Line	:	PO BOX 947121
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30394-7121
Country	:	US
Telephone Number	:	954-967-4248
Fax Number	:	954-967-4253

Provider Business Practice Location Address
First Line	:	2741 STIRLING RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33312-6505
Country	:	US
Telephone Number	:	954-967-4248
Fax Number	:	954-967-4253

Authorized Official
Title or Position	:	TRAINING & EMS ASSISTANT DIVISION C
Name	:	SIMON SERRAO
Credential	:
Telephone Number	:	954-921-3451

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	12/06/2021

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Directions to “CITY OF HOLLYWOOD ” Practice Location

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