Healthcare Provider Details

I. General information

NPI: 1912905829
Provider Name (Legal Business Name): ISLAMORADA VILLAGE OF ISLANDS A FLORIDA MUNICIPALITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86800 OVERSEAS HWY
ISLAMORADA FL
33036-3162
US

IV. Provider business mailing address

420 WALMART WAY PMB 510
DAHLONEGA GA
30533-0818
US

V. Phone/Fax

Practice location:
  • Phone: 305-664-6490
  • Fax: 305-852-5195
Mailing address:
  • Phone: 877-288-8561
  • Fax: 866-889-1258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberALS4406
License Number StateFL

VIII. Authorized Official

Name: MR. WILLIAM A WAGNER III
Title or Position: FIRE CHIEF
Credential:
Phone: 305-664-6490