Provider Demographics
NPI:1215906938
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:ADMINISTRATIVE SERVICES DIRECTOR 1
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:TOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-674-4041
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:MOORE HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33471-0489
Mailing Address - Country:US
Mailing Address - Phone:863-946-0707
Mailing Address - Fax:863-946-3097
Practice Address - Street 1:1021 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:MOORE HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33471-6206
Practice Address - Country:US
Practice Address - Phone:863-946-0707
Practice Address - Fax:863-946-3097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-15
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0279323-00Medicaid
FL77049OtherBLUE CROSS BLUE SHIELD