Provider Demographics
NPI:1861437774
Name:COUNTY OF BRADFORD
Entity type:Organization
Organization Name:COUNTY OF BRADFORD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:904-966-6911
Mailing Address - Street 1:PO BOX B
Mailing Address - Street 2:945 NORTH TEMPLE AVENUE SUITE C
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-2110
Mailing Address - Country:US
Mailing Address - Phone:904-966-6905
Mailing Address - Fax:904-966-6171
Practice Address - Street 1:945 N TEMPLE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-2110
Practice Address - Country:US
Practice Address - Phone:904-966-6911
Practice Address - Fax:904-966-6171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF BRADFORD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-17
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL099404900Medicaid
FL099404900Medicaid