Provider Demographics
NPI:1528733623
Name:CITY OF COCONUT CREEK
Entity type:Organization
Organization Name:CITY OF COCONUT CREEK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLIZZARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-973-6706
Mailing Address - Street 1:PO BOX 100314
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3314
Mailing Address - Country:US
Mailing Address - Phone:800-226-1012
Mailing Address - Fax:833-953-0588
Practice Address - Street 1:4555 SOL PRESS BLVD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-1601
Practice Address - Country:US
Practice Address - Phone:954-973-6706
Practice Address - Fax:954-420-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP02634113OtherRAILROAD
FL112679700Medicaid