Provider Demographics
NPI:1124293279
Name:COUNTY OF GLADES OFFICE OF CLERK BOARD COUNTY COMMISSIONERS
Entity type:Organization
Organization Name:COUNTY OF GLADES OFFICE OF CLERK BOARD COUNTY COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-946-6020
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:MOORE HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33471-0481
Mailing Address - Country:US
Mailing Address - Phone:863-946-6020
Mailing Address - Fax:863-946-1091
Practice Address - Street 1:4889 E STATE ROAD 78
Practice Address - Street 2:
Practice Address - City:MOORE HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33471-6209
Practice Address - Country:US
Practice Address - Phone:863-946-6020
Practice Address - Fax:863-946-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27763416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA0530Medicare PIN