MEDICARE: COUNTY OF PUTNAM BOARD OF 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	002606	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	406590357	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	A0374	OTHER	BCBS OF FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0823376	OTHER	UNITED MINE WORKERS
5	087914000	OTHER	BLACK LUNG
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659362986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF PUTNAM BOARD OF COMMISSIONERS

Provider Business Mailing Address
First Line	:	PO BOX 758
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32178-0758
Country	:	US
Telephone Number	:	386-329-0240
Fax Number	:	386-326-2795

Provider Business Practice Location Address
First Line	:	410 S STATE ROAD 19
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-3941
Country	:	US
Telephone Number	:	386-329-0240
Fax Number	:	386-326-2795

Authorized Official
Title or Position	:	FMS MANAGER / DEPUTY CHIEF
Name	:	MICHAEL LANIER PATTERSON
Credential	:	PARAMEDIC
Telephone Number	:	386-329-0892

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	01/08/2010

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

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