Provider Demographics
NPI:1154395390
Name:FLORIDA DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH RN
Authorized Official - Phone:352-486-5300
Mailing Address - Street 1:66 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:FL
Mailing Address - Zip Code:32621-6338
Mailing Address - Country:US
Mailing Address - Phone:352-486-5300
Mailing Address - Fax:352-486-5306
Practice Address - Street 1:66 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:FL
Practice Address - Zip Code:32621-6338
Practice Address - Country:US
Practice Address - Phone:352-486-5300
Practice Address - Fax:352-486-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
72945OtherBLUE CROSS BLUE SHIELD
FL027948091Medicaid
72945OtherBLUE CROSS BLUE SHIELD