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11265 Alumni Way Jacksonville FL 32246-6685 | |
| (904) 398-2020 | |
| (904) 724-2172 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 11265 Alumni Way, Jacksonville, Florida |
| Authorized Official Name and Position | Mark A Ulerie (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9043982020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11265 Alumni Way Jacksonville FL 32246-6685 Ph: (904) 398-2020 | 11265 Alumni Way Jacksonville FL 32246-6685 Ph: (904) 398-2020 |
| NPI Number | 1154430197 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 09/16/2021 |
| Certification Date | 09/16/2021 |
| Medicare PECOS PAC ID | 5698727873 |
|---|---|
| Medicare Enrollment ID | O20210512003164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154430197 | NPI | - | NPPES |
| 678170596 | Medicaid | FL |
| Provider Name | Pradeep Arora |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366466476 PECOS PAC ID: 6103816699 Enrollment ID: I20040518000602 |
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