Provider Demographics
NPI:1962409912
Name:CITY OF HOLLYWOOD
Entity type:Organization
Organization Name:CITY OF HOLLYWOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRAINING & EMS ASSISTANT DIVISION C
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-921-3451
Mailing Address - Street 1:PO BOX 947121
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7121
Mailing Address - Country:US
Mailing Address - Phone:954-967-4248
Mailing Address - Fax:954-967-4253
Practice Address - Street 1:2741 STIRLING RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33312-6505
Practice Address - Country:US
Practice Address - Phone:954-967-4248
Practice Address - Fax:954-967-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
FL3345341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL088031100Medicaid
590098217OtherRAILROAD PROVIDER ID
FLA0389Medicare ID - Type Unspecified