| Beachside Primary Care LLC | |
|
1825 3rd St N Ste B Jacksonville Beach FL 32250-4840 | |
| (904) 595-5826 | |
| (904) 595-5827 |
| Full Name | Beachside Primary Care LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 1825 3rd St N Ste B, Jacksonville Beach, Florida |
| Authorized Official Name and Position | Deborah Ghandour (PRESIDENT) |
| Authorized Official Contact | 9045955826 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beachside Primary Care LLC 1825 3rd St N Ste B Jacksonville Beach FL 32250-4840 | Beachside Primary Care LLC 1825 3rd St N Ste B Jacksonville Beach FL 32250-4840 Ph: (904) 595-5826 |
| NPI Number | 1386364032 |
|---|---|
| Provider Enumeration Date | 09/01/2022 |
| Last Update Date | 12/16/2022 |
| Certification Date | 12/16/2022 |
| Medicare PECOS PAC ID | 5991174666 |
|---|---|
| Medicare Enrollment ID | O20221220001601 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386364032 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Deborah L Ghandour |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1053329599 PECOS PAC ID: 1254352164 Enrollment ID: I20051207000581 |
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