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6639 Southpoint Pkwy Ste 108 Jacksonville FL 32216-8041 | |
| (904) 438-7640 | |
| (904) 438-7656 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 6639 Southpoint Pkwy, Jacksonville, Florida |
| Authorized Official Name and Position | Brian Phillip Farley (VP & SECRETARY) |
| Authorized Official Contact | 6157169335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6183 Paseo Del Norte, Ste 200 Carlsbad CA 92011-1155 Ph: (855) 259-2288 | 6639 Southpoint Pkwy Ste 108 Jacksonville FL 32216-8041 Ph: (904) 438-7640 |
| NPI Number | 1770951527 |
|---|---|
| Provider Enumeration Date | 09/10/2015 |
| Last Update Date | 12/03/2024 |
| Certification Date | 12/03/2024 |
| Medicare PECOS PAC ID | 4082048061 |
|---|---|
| Medicare Enrollment ID | O20191227001879 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770951527 | NPI | - | NPPES |
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