| Issa.med P.a. | |
|
2 Pavillion Place Penney Farms FL 32079 | |
| (217) 416-6431 | |
| Not Available |
| Full Name | Issa.med P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 2 Pavillion Place, Penney Farms, Florida |
| Authorized Official Name and Position | Hani Issa (PRESIDENT) |
| Authorized Official Contact | 2174166431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Issa.med P.a. 1907 Atlantic Blvd Ste 1 Jacksonville FL 32207-3405 Ph: () - | Issa.med P.a. 2 Pavillion Place Penney Farms FL 32079 Ph: (217) 416-6431 |
| NPI Number | 1376217364 |
|---|---|
| Provider Enumeration Date | 08/04/2021 |
| Last Update Date | 08/04/2021 |
| Medicare PECOS PAC ID | 8628472537 |
|---|---|
| Medicare Enrollment ID | O20210813000780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376217364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Hani Issa |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1619144045 PECOS PAC ID: 2668621236 Enrollment ID: I20170928001398 |
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