=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245241603
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF CORAL SPRINGS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 03/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4150 NW 120TH AVE
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065-7622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-612-7638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 100256
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29202-3256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-612-7638
-----------------------------------------------------
Fax | 954-344-5933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIVISION CHIEF
-----------------------------------------------------
Name | JOHN BARRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-612-7638
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 3224
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------