Organization
CITY OF PEMBROKE PINES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN PENICK (DIVISION CHIEF OF RESCUE)
(954) 499-9584
Entity
Organization
Contact information
Practice address
9500 PINES BLVD, BLDG B, PEMBROKE PINES, FL 33024-6258
(954) 499-9600
Mailing address
9500 PINES BLVD, BUILDING B, PEMBROKE PINES, FL 33024-6258
(954) 499-9581
(954) 517-8432
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
2813
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085063200
—
FL
01
—
590000614
PALMETTO GBA RAILROAD MED
FL
01
—
A0444
BC/BS OF FLORIDA
FL
01
—
N7076
STAY WELL HEALTH PLAN
FL
Enumeration date
02/08/2007
Last updated
04/17/2017
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