=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912565706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METRO-STATE EMERGENCY SERVICES UNIT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2019
-----------------------------------------------------
Last Update Date | 06/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3804 N ORANGE BLOSSOM TRL
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-2772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-808-6573
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 N ORLANDO AVE STE 313
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789-7310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-808-6573
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSICA BOLDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-808-6573
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------