| My Family Doctor, Pa | |
|
111 Nw 183rd St Ste 306 Miami FL 33169-4599 | |
| (305) 705-6688 | |
| Not Available |
| Full Name | My Family Doctor, Pa |
|---|---|
| Speciality | General Practice |
| Location | 111 Nw 183rd St Ste 306, Miami, Florida |
| Authorized Official Name and Position | Arnika Renee Jackson (PRESIDENT/OFFICE MANAGER) |
| Authorized Official Contact | 3057056688 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Family Doctor, Pa 111 Nw 183rd St Ste 306 Miami FL 33169-4599 Ph: (305) 705-6688 | My Family Doctor, Pa 111 Nw 183rd St Ste 306 Miami FL 33169-4599 Ph: (305) 705-6688 |
| NPI Number | 1184115263 |
|---|---|
| Provider Enumeration Date | 05/23/2018 |
| Last Update Date | 05/23/2018 |
| Medicare PECOS PAC ID | 4789923228 |
|---|---|
| Medicare Enrollment ID | O20190228001191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184115263 | NPI | - | NPPES |
| 1184607541 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ME37656 (Florida) | Primary |
| Provider Name | John Jackson |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1184607541 PECOS PAC ID: 2062502594 Enrollment ID: I20071220000130 |
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