County of Hamilton

Organization Active NPI Land Ambulance · Jasper, FL

NPI 1003851767 · NPPES record last updated May 10, 2012

Key facts

NPI
1003851767
Entity type
Organization (NPI type 2)
Primary specialty
Land Ambulance 3416L0300X
License
002519 (FL)
Legal business name
COUNTY OF HAMILTON
Practice address
207 1St St NE
902 US Hwy 41 NW
Jasper, FL 32052-6633
Phone
(386) 792-1288
Fax
(386) 792-6432
NPI assigned
Jun 18, 2006
Organization subpart
No

Authorized official

Name
Ms. Lisa L. Harris
Title
Accounts Manager
Phone
(386) 792-6817

Medicare participation

Medicare fee-for-service enrollment
Enrolled in FL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20120511000264 FL Part B Supplier - Ambulance Service Supplier 6103089008 Practice locations: Jasper, FL

National Provider Directory

Locations

902 US Highway 41 NW
Jasper, FL 32052
Phone (386) 792-1288

207 1st St NE
Rm 6
Jasper, FL 32052

207 1st St NE
Jasper, FL 32052

306 8th Ave NW
Jasper, FL 32052
Phone (386) 792-6447

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 002519 FL Yes

Addresses

Primary practice location

207 1St St NE
902 US Hwy 41 NW
Jasper, FL 32052-6633

Mailing address

207 1St St NE
Jasper, FL 32052-6633
Phone (386) 792-1288

Other identifiers

IdentifierTypeStateIssuer
088053100MedicaidFL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 10, 2012.

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1003851767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 1ST ST NE",
            "city": "JASPER",
            "state": "FL",
            "postal_code": "320526633",
            "telephone_number": "386-792-1288",
            "fax_number": "386-792-6432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 1ST ST NE",
            "address_2": "902 US HWY 41 NW",
            "city": "JASPER",
            "state": "FL",
            "postal_code": "320526633",
            "telephone_number": "386-792-1288",
            "fax_number": "386-792-6432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF HAMILTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "386-792-6817",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "FL",
            "license": "002519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "088053100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, FL

All providers in Jasper, FL · Land Ambulance in Florida

Sources for this page

Verify at the official NPI Registry.