| Mrs Maryann Kenneson, MD | |
|
1895 Kingsley Ave Ste 903, Orange Park, FL 32073-4410 | |
| (904) 644-8353 | |
| (904) 644-8289 |
| Full Name | Mrs Maryann Kenneson |
|---|---|
| Gender | Female |
| Speciality | Urology |
| Experience | 22 Years |
| Location | 1895 Kingsley Ave Ste 903, Orange Park, Florida |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790011062 | NPI | - | NPPES |
| 0056336 | Medicaid | OH | |
| 14N6L | Other | FL | BCBS |
| 006734700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 35098042 (Ohio) | Secondary |
| 208800000X | Urology | ME92864 (Florida) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Ascension St Vincent's Clay County | Middleburg, FL | Hospital |
| Baptist Health Medical Center - Jacksonville | Jacksonville, FL | Hospital |
| Ascension St Vincent's Riverside | Jacksonville, FL | Hospital |
| Orange Park Medical Center | Orange park, FL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| St Vincent's Ambulatory Care Inc | 2860411188 | 255 |
| Entity Name | St Vincent's Ambulatory Care Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1417987124 PECOS PAC ID: 2860411188 Enrollment ID: O20051116000430 |
| Mailing Address | Practice Location Address |
|---|---|
| Mrs Maryann Kenneson, MD 10881 San Jose Blvd, Jacksonville, FL 32223-6612 Ph: (904) 260-3022 | Mrs Maryann Kenneson, MD 1895 Kingsley Ave Ste 903, Orange Park, FL 32073-4410 Ph: (904) 644-8353 |
Robert A. Marino, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 2045 Professional Center Dr, Orange Park, FL 32073 Phone: 904-276-1580 Fax: 904-276-9586 | |
Dr. David Scott Bargnesi, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 1715 Village Way, Orange Park, FL 32073 Phone: 904-264-8418 Fax: 904-264-9692 | |
Dr. Marc Hepner Blasser, M.D. Urology Medicare: Medicare Enrolled Practice Location: 1715 Village Way, Orange Park, FL 32073 Phone: 904-264-8418 Fax: 904-264-9692 | |
Christopher Moore, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 1715 Village Way, Orange Park, FL 32073 Phone: 904-264-8418 | |
Dr. James Emmett Kaelin, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 1715 Village Way, Orange Park, FL 32073 Phone: 904-264-8418 |