MEDICARE: FALCK SOUTHEAST II CORP

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

General Provider Information

NPI Number	:	1922355130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALCK SOUTHEAST II CORP

Provider Business Mailing Address
First Line	:	PO BOX 538598
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-8598
Country	:	US
Telephone Number	:	888-876-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2570 S PARK RD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-3814
Country	:	US
Telephone Number	:	888-876-2100
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHARLES MAYMON
Credential	:
Telephone Number	:	888-876-2100

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	04/16/2018

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