MEDICARE: COUNTY OF DIXIE BOARD OF COUNTY COMM

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	ALS1501	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590072343	OTHER		RAILROAD MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730162488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF DIXIE BOARD OF COUNTY COMM

Provider Business Mailing Address
First Line	:	P O BOX 2009
Second Line	:
City	:	CROSS CITY
State	:	FL
Zip	:	32628-2009
Country	:	US
Telephone Number	:	352-498-1240
Fax Number	:	352-498-1244

Provider Business Practice Location Address
First Line	:	17600 SE 19 HIGHWAY
Second Line	:
City	:	CROSS CITY
State	:	FL
Zip	:	32628-3506
Country	:	US
Telephone Number	:	352-498-1240
Fax Number	:	352-498-1244

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. TIM ALEXANDER
Credential	:
Telephone Number	:	352-498-1240

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	04/13/2012

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Directions to “COUNTY OF DIXIE BOARD OF COUNTY COMM ” Practice Location

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