Healthcare Provider Details

I. General information

NPI: 1124293279
Provider Name (Legal Business Name): COUNTY OF GLADES OFFICE OF CLERK BOARD COUNTY COMMISSIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4889 E STATE ROAD 78
MOORE HAVEN FL
33471-6209
US

IV. Provider business mailing address

PO BOX 481
MOORE HAVEN FL
33471-0481
US

V. Phone/Fax

Practice location:
  • Phone: 863-946-6020
  • Fax: 863-946-1091
Mailing address:
  • Phone: 863-946-6020
  • Fax: 863-946-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2776
License Number StateFL

VIII. Authorized Official

Name: ANGELA R. SNOW
Title or Position: BILLING CLERK
Credential:
Phone: 863-946-6020