| Angel Kids Pa | |
|
13241 Bartram Park Blvd Suite 209 Jacksonville FL 32258 | |
| (904) 242-4220 | |
| (904) 674-2313 |
| Full Name | Angel Kids Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 13241 Bartram Park Blvd, Jacksonville, Florida |
| Authorized Official Name and Position | Ashraf A Abu Affan (PRESIDENT) |
| Authorized Official Contact | 9042424220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angel Kids Pa 13241 Bartram Park Blvd. Suite 209 Jacksonville FL 32258 Ph: (904) 242-4220 | Angel Kids Pa 13241 Bartram Park Blvd Suite 209 Jacksonville FL 32258 Ph: (904) 242-4220 |
| NPI Number | 1124162854 |
|---|---|
| Provider Enumeration Date | 02/16/2007 |
| Last Update Date | 07/28/2015 |
| Medicare PECOS PAC ID | 1052742103 |
|---|---|
| Medicare Enrollment ID | O20200506000154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124162854 | NPI | - | NPPES |
| 270166900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Ashraf Ali Affan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477538593 PECOS PAC ID: 2961833017 Enrollment ID: I20200506000199 |
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