| The Practice | |
|
3547 Hendricks Ave Jacksonville FL 32207-5309 | |
| (904) 877-1100 | |
| (904) 877-1200 |
| Full Name | The Practice |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3547 Hendricks Ave, Jacksonville, Florida |
| Authorized Official Name and Position | Charles B Maddix (PRESIDENT & OWNER) |
| Authorized Official Contact | 9048771100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Practice 3547 Hendricks Ave Jacksonville FL 32207-5309 Ph: (904) 877-1100 | The Practice 3547 Hendricks Ave Jacksonville FL 32207-5309 Ph: (904) 877-1100 |
| NPI Number | 1942765300 |
|---|---|
| Provider Enumeration Date | 02/08/2019 |
| Last Update Date | 07/17/2023 |
| Certification Date | 07/17/2023 |
| Medicare PECOS PAC ID | 9133451271 |
|---|---|
| Medicare Enrollment ID | O20191023000540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942765300 | NPI | - | NPPES |
| Provider Name | Raul Soto-acosta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619991106 PECOS PAC ID: 5799727228 Enrollment ID: I20050525000572 |
| Provider Name | Sharon Reiley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235212549 PECOS PAC ID: 1456664614 Enrollment ID: I20150716001633 |
| Provider Name | Charles Maddix |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790047926 PECOS PAC ID: 4789989252 Enrollment ID: I20160222000162 |
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