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3625 University Blvd S Jacksonville FL 32216-4207 | |
| (904) 399-6111 | |
| (904) 399-6849 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 3625 University Blvd S, Jacksonville, Florida |
| Authorized Official Name and Position | Kevin Mckeown (CFO) |
| Authorized Official Contact | 9047026573 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3625 University Blvd S Jacksonville FL 32216-4207 Ph: (904) 399-6111 | 3625 University Blvd S Jacksonville FL 32216-4207 Ph: (904) 399-6111 |
| NPI Number | 1083997779 |
|---|---|
| Provider Enumeration Date | 09/20/2011 |
| Last Update Date | 03/30/2022 |
| Certification Date | 03/30/2022 |
| Medicare PECOS PAC ID | 5799788303 |
|---|---|
| Medicare Enrollment ID | O20120921000787 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083997779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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