Healthcare Provider Details

I. General information

NPI: 1558385229
Provider Name (Legal Business Name): FT MYERS BEACH FIRE CONTROL DIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 VOORHIS ST
FORT MYERS BEACH FL
33931-3634
US

IV. Provider business mailing address

100 VOORHIS ST
FORT MYERS BEACH FL
33931-3634
US

V. Phone/Fax

Practice location:
  • Phone: 239-463-6163
  • Fax: 239-463-6761
Mailing address:
  • Phone: 239-463-6163
  • Fax: 239-463-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number002605
License Number StateFL

VIII. Authorized Official

Name: DARREN WHITE
Title or Position: FIRE CHIEF
Credential:
Phone: 239-590-4200