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General NPI Number Information
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NPI Number | 1205982774
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Entity Type | Organization
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Legal Business Name | COUNTY OF LIBERTY BOARD OF COUNTY COMMISSIONERS
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 12503 NW VIRGINIA G WEAVER ST
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City | BRISTOL
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State | FL
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Zip | 32321-3340
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Country | US
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Telephone | 850-643-5866
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Fax | 850-643-3499
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Provider Business Mailing Address
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Address Line | PO BOX 399
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City | BRISTOL
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State | FL
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Zip | 32321-0399
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Country | US
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Telephone | 850-643-5866
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Fax | 850-643-3499
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Authorized Official
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Title or Position | DIRECTOR
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Name | ROBERT HILL
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Credential |
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Telephone | 850-643-2866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 002611
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License Number State | FL
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