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General NPI Number Information
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NPI Number | 1649261744
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Entity Type | Organization
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Legal Business Name | ST LUCIE COUNTY FIRE DISTRICT
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 5160 NW MILNER DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-3392
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Country | US
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Telephone | 772-621-3321
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Fax | 772-621-3610
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Provider Business Mailing Address
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Address Line | 5160 NW MILNER DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-3392
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Country | US
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Telephone | 772-621-3321
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Fax | 772-621-3610
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Authorized Official
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Title or Position | AMBULANCE BILLING SUPERVISOR
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Name | MRS. LISA A HANNOLD
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Credential |
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Telephone | 772-621-3352
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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 | 2654
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License Number State | FL
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