| Amd Primary Care | |
|
1202 Kingsley Ave Orange Park FL 32073-4632 | |
| (877) 228-1221 | |
| (877) 842-4020 |
| Full Name | Amd Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 1202 Kingsley Ave, Orange Park, Florida |
| Authorized Official Name and Position | Maria D Maynoldi (ADMINISTRATOR) |
| Authorized Official Contact | 9045794766 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amd Primary Care 5000-18 Us Hwy 17 S # 241 Fleming Island FL 32003 Ph: (877) 228-1221 | Amd Primary Care 1202 Kingsley Ave Orange Park FL 32073-4632 Ph: (877) 228-1221 |
| NPI Number | 1730682808 |
|---|---|
| Provider Enumeration Date | 03/14/2018 |
| Last Update Date | 11/13/2018 |
| Medicare PECOS PAC ID | 2163776667 |
|---|---|
| Medicare Enrollment ID | O20181120002056 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730682808 | NPI | - | NPPES |
| ME130811 | Other | FL | DAVID MAYNOLDI'S FL MED LIC |
| 1144591249 | Other | FL | DAVID MAYNOLDI MD NPI # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME130811 (Florida) | Primary |
| Provider Name | David Maynoldi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144591249 PECOS PAC ID: 6002136934 Enrollment ID: I20170621000707 |
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