=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548242571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAY COUNTY BOARD OF COUNTY COMMISSIONERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2005
-----------------------------------------------------
Last Update Date | 08/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2519 STATE ROAD 16 W
-----------------------------------------------------
City | GREEN COVE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32043-4819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-529-5805
-----------------------------------------------------
Fax | 904-284-8015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 947668
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30394-7668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-529-5805
-----------------------------------------------------
Fax | 904-284-8015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | MR. DAVID E MOTES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-541-2778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 341600000X
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------