MEDICARE: SOUTH WALTON FIRE DISTRICT

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	002419	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A0736	OTHER	FL	BLUE CROSS PROVIDER NUMBE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427053420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH WALTON FIRE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 1226
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-1226
Country	:	US
Telephone Number	:	850-267-1298
Fax Number	:	850-267-3294

Provider Business Practice Location Address
First Line	:	911 CR 393 N
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-1226
Country	:	US
Telephone Number	:	850-267-1298
Fax Number	:	850-267-3294

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	LES HALLMAN
Credential	:
Telephone Number	:	850-267-1298

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/22/2020

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Directions to “SOUTH WALTON FIRE DISTRICT ” Practice Location

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