| Regenerative Medicine Of North Florida Llc | |
|
4540 Southside Blvd Ste 401 Jacksonville FL 32216-5488 | |
| (321) 323-3618 | |
| Not Available |
| Full Name | Regenerative Medicine Of North Florida Llc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 4540 Southside Blvd Ste 401, Jacksonville, Florida |
| Authorized Official Name and Position | Rafael Foss (OWNER) |
| Authorized Official Contact | 7863701111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regenerative Medicine Of North Florida Llc Po Box 24556 Jacksonville FL 32241-4556 Ph: (786) 370-1111 | Regenerative Medicine Of North Florida Llc 4540 Southside Blvd Ste 401 Jacksonville FL 32216-5488 Ph: (321) 323-3618 |
| NPI Number | 1093331456 |
|---|---|
| Provider Enumeration Date | 06/22/2020 |
| Last Update Date | 12/10/2023 |
| Medicare PECOS PAC ID | 0941643852 |
|---|---|
| Medicare Enrollment ID | O20240207004012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093331456 | NPI | - | NPPES |
| Provider Name | Barry L Efron |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1205823499 PECOS PAC ID: 5092817577 Enrollment ID: I20080404000286 |
| Provider Name | Michael Leon Sevick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851940613 PECOS PAC ID: 1355737594 Enrollment ID: I20220415000173 |
| Provider Name | Phillip Ulyanovskiy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821471665 PECOS PAC ID: 8325395403 Enrollment ID: I20240313001180 |
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