Healthcare Provider Details

I. General information

NPI: 1003851767
Provider Name (Legal Business Name): COUNTY OF HAMILTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 1ST ST NE 902 US HWY 41 NW
JASPER FL
32052-6633
US

IV. Provider business mailing address

207 1ST ST NE
JASPER FL
32052-6633
US

V. Phone/Fax

Practice location:
  • Phone: 386-792-1288
  • Fax: 386-792-6432
Mailing address:
  • Phone: 386-792-1288
  • Fax: 386-792-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number002519
License Number StateFL

VIII. Authorized Official

Name: MS. LISA L. HARRIS
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 386-792-6817