Jacksonville Psychiatric Association Inc | |
10175 Fortune Pkwy Suite 104 Jacksonville FL 32256-6746 | |
(904) 379-8748 | |
(904) 379-8796 |
Full Name | Jacksonville Psychiatric Association Inc |
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Speciality | Psychiatry & Neurology |
Location | 10175 Fortune Pkwy, Jacksonville, Florida |
Authorized Official Name and Position | Imtiaz Rasul (OWNER) |
Authorized Official Contact | 9739010394 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Jacksonville Psychiatric Association Inc 10175 Fortune Pkwy Suite 104 Jacksonville FL 32256-6746 Ph: (973) 901-0394 | Jacksonville Psychiatric Association Inc 10175 Fortune Pkwy Suite 104 Jacksonville FL 32256-6746 Ph: (904) 379-8748 |
NPI Number | 1205261765 |
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Provider Enumeration Date | 09/03/2013 |
Last Update Date | 11/07/2014 |
Medicare PECOS PAC ID | 2668607722 |
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Medicare Enrollment ID | O20131105001673 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205261765 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | ME112178 (Florida) | Primary |
Provider Name | Imtiaz Rasul |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1205071719 PECOS PAC ID: 4385775584 Enrollment ID: I20130111000326 |
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