Provider Demographics
NPI:1811476930
Name:COUNTY OF LAKE OFFICE CLERK BOARD COUNTY COMMISSIONERS
Entity type:Organization
Organization Name:COUNTY OF LAKE OFFICE CLERK BOARD COUNTY COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:I
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-343-9850
Mailing Address - Street 1:315 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3813
Mailing Address - Country:US
Mailing Address - Phone:352-343-9850
Mailing Address - Fax:
Practice Address - Street 1:315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3813
Practice Address - Country:US
Practice Address - Phone:352-343-9850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10007341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance