Provider Demographics
NPI:1649261744
Name:ST LUCIE COUNTY FIRE DISTRICT
Entity type:Organization
Organization Name:ST LUCIE COUNTY FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-621-3352
Mailing Address - Street 1:5160 NW MILNER DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3392
Mailing Address - Country:US
Mailing Address - Phone:772-621-3321
Mailing Address - Fax:772-621-3610
Practice Address - Street 1:5160 NW MILNER DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3392
Practice Address - Country:US
Practice Address - Phone:772-621-3321
Practice Address - Fax:772-621-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26543416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL088065500Medicaid