| Mainland Physicians Group LLC | |
|
100 Arricola Ave St Augustine FL 32080-4515 | |
| (904) 825-4368 | |
| (904) 825-9107 |
| Full Name | Mainland Physicians Group LLC |
|---|---|
| Speciality | Family Medicine - Geriatric Medicine |
| Location | 100 Arricola Ave, St Augustine, Florida |
| Authorized Official Name and Position | John Paul James Shaddock (DIRECTOR OF NETWORK MANAGMENT) |
| Authorized Official Contact | 8503416322 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mainland Physicians Group LLC 100 Arricola Ave St Augustine FL 32080-4515 Ph: (904) 825-4368 | Mainland Physicians Group LLC 100 Arricola Ave St Augustine FL 32080-4515 Ph: (904) 825-4368 |
| NPI Number | 1003419763 |
|---|---|
| Provider Enumeration Date | 11/17/2020 |
| Last Update Date | 11/17/2020 |
| Certification Date | 11/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003419763 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (NU) | Primary |
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