MEDICARE: CLAY COUNTY 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	341600000X	Ambulance	341600000X	FL
2	341600000X	Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	162909000	OTHER	US DEPT OF LABOR W/C
2	0081031200	OTHER	FEDERAL BLACK LUNG
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548242571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAY COUNTY BOARD OF COUNTY COMMISSIONERS

Provider Business Mailing Address
First Line	:	PO BOX 947668
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30394-7668
Country	:	US
Telephone Number	:	904-529-5805
Fax Number	:	904-284-8015

Provider Business Practice Location Address
First Line	:	2519 STATE ROAD 16 W
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-4819
Country	:	US
Telephone Number	:	904-529-5805
Fax Number	:	904-284-8015

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MR. DAVID E MOTES
Credential	:
Telephone Number	:	904-541-2778

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/19/2024

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Directions to “CLAY COUNTY BOARD OF COUNTY COMMISSIONERS ” Practice Location

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