Active NPI
County of Bradford
Doing business as Bradford County EMS
- Land Ambulance
- Starke, FL
National Provider Identifier
1861437774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 2670
- Legal business name
- COUNTY OF BRADFORD
- Doing business as
- Bradford County EMS
- Practice address
- 945 N Temple Ave
Suite C
Starke, FL 32091-2110 - Phone
- (904) 966-6911
- Fax
- (904) 966-6171
- NPI assigned
- Jun 17, 2006
- Last updated
- Jul 25, 2012
- Organization subpart
- Yes
- Parent organization
- COUNTY OF BRADFORD
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Randall A. Parrish, PARAMEDIC
- Title
- Director
- Phone
- (904) 966-6911
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 2670 | FL | Primary |
Addresses
Primary practice location
945 N Temple Ave
Suite C
Starke, FL 32091-2110
Mailing address
PO Box B
945 North Temple Avenue Suite C
Starke, FL 32091-2110
Phone (904) 966-6905
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 099404900 | Medicaid | FL |
Other names 1
- Bradford County EMS
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120523000043 | FL | Part B Supplier - Ambulance Service Supplier | 9234392648 | Practice locations: Starke, FL |
National Provider Directory
National Provider Directory- Part of
- County of Bradford
Locations
945 N Temple Ave
#C
Starke, FL 32091
Phone (904) 966-6911
945 N Temple Ave
Ste C
Starke, FL 32091
945C N Temple Ave
Starke, FL 32091
Phone (904) 966-6911
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1343174400000",
"number": "1861437774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX B",
"address_2": "945 NORTH TEMPLE AVENUE SUITE C",
"city": "STARKE",
"state": "FL",
"postal_code": "320912110",
"telephone_number": "904-966-6905",
"fax_number": "904-966-6171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "945 N TEMPLE AVE",
"address_2": "SUITE C",
"city": "STARKE",
"state": "FL",
"postal_code": "320912110",
"telephone_number": "904-966-6911",
"fax_number": "904-966-6171"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTY OF BRADFORD",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COUNTY OF BRADFORD",
"enumeration_date": "2006-06-17",
"last_updated": "2012-07-25",
"status": "A",
"authorized_official_last_name": "PARRISH",
"authorized_official_first_name": "RANDALL",
"authorized_official_middle_name": "A.",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "904-966-6911",
"authorized_official_credential": "PARAMEDIC"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "FL",
"license": "2670",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "099404900",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Bradford County EMS",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Starke, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.