MEDICARE: COUNTY OF WALTON BOARD OF COUNTY COMMISSIONERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	3606	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174593255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF WALTON BOARD OF COUNTY COMMISSIONERS

Provider Business Mailing Address
First Line	:	PO BOX 1460
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-7460
Country	:	US
Telephone Number	:	850-892-6162
Fax Number	:	850-951-2911

Provider Business Practice Location Address
First Line	:	63 BO PETE MANOR RD
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-2943
Country	:	US
Telephone Number	:	850-892-6162
Fax Number	:	850-951-2911

Authorized Official
Title or Position	:	INTERIM FIRE CHIEF
Name	:	BOBBY A MARTIN
Credential	:
Telephone Number	:	850-892-6162

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	10/01/2014

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