Healthcare Provider Details

I. General information

NPI: 1427053420
Provider Name (Legal Business Name): SOUTH WALTON FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 CR 393 N
SANTA ROSA BEACH FL
32459-1226
US

IV. Provider business mailing address

PO BOX 1226
SANTA ROSA BEACH FL
32459-1226
US

V. Phone/Fax

Practice location:
  • Phone: 850-267-1298
  • Fax: 850-267-3294
Mailing address:
  • Phone: 850-267-1298
  • Fax: 850-267-3294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number002419
License Number StateFL

VIII. Authorized Official

Name: LES HALLMAN
Title or Position: FIRE CHIEF
Credential:
Phone: 850-267-1298