Provider Demographics
NPI:1487724969
Name:FLORIDA DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CULBREATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-526-2412
Mailing Address - Street 1:4979 HEALTHY WAY
Mailing Address - Street 2:PO BOX 310
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-7993
Mailing Address - Country:US
Mailing Address - Phone:850-526-2412
Mailing Address - Fax:850-718-0383
Practice Address - Street 1:4979 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-7993
Practice Address - Country:US
Practice Address - Phone:850-526-2412
Practice Address - Fax:850-718-0383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME866002083P0901X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027942100Medicaid
FL97896OtherBCBS
81034Medicare UPIN
FL97896AMedicare PIN