=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578723078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEVY COUNTY BOARD COUNTY COMMISSION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2008
-----------------------------------------------------
Last Update Date | 06/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 970 E HATHAWAY AVE
-----------------------------------------------------
City | BRONSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32621-6707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-486-3485
-----------------------------------------------------
Fax | 352-486-3312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 970 E HATHAWAY AVE
-----------------------------------------------------
City | BRONSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32621-6707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-486-3485
-----------------------------------------------------
Fax | 352-486-3312
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONS MANAGER
-----------------------------------------------------
Name | CONNIE CONLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-486-3485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------