| Black Bag Medical Inc | |
|
4320 Deerwood Lake Pkwy Suite 101, Pmb 321 Jacksonville FL 32216-1177 | |
| (904) 371-4051 | |
| (904) 807-4839 |
| Full Name | Black Bag Medical Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4320 Deerwood Lake Pkwy, Jacksonville, Florida |
| Authorized Official Name and Position | Brian Layne Stephens (PRESIDENT) |
| Authorized Official Contact | 9043714051 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Bag Medical Inc 4320 Deerwood Lake Pkwy Suite 101, Pmb 321 Jacksonville FL 32216-1177 Ph: (904) 371-4051 | Black Bag Medical Inc 4320 Deerwood Lake Pkwy Suite 101, Pmb 321 Jacksonville FL 32216-1177 Ph: (904) 371-4051 |
| NPI Number | 1750440988 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5698777100 |
|---|---|
| Medicare Enrollment ID | O20070213000591 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750440988 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brian L Stephens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295761245 PECOS PAC ID: 7416849948 Enrollment ID: I20040329000434 |
| Provider Name | Nam-phuong T Lu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356374946 PECOS PAC ID: 7719044429 Enrollment ID: I20090325000312 |
| Provider Name | Tea Kuharic Stephens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861613663 PECOS PAC ID: 3375616386 Enrollment ID: I20100308000329 |
| Provider Name | Neel G Karnani |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1700846565 PECOS PAC ID: 1153571062 Enrollment ID: I20121030000041 |
| Provider Name | Georganna Michelle Rosel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1033436696 PECOS PAC ID: 8224271184 Enrollment ID: I20180628002123 |
| Provider Name | Carol Christine Sickels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356977888 PECOS PAC ID: 2365872850 Enrollment ID: I20200424000256 |
| Provider Name | Diana V Budnik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891381133 PECOS PAC ID: 0648658658 Enrollment ID: I20220603000688 |
| Provider Name | Estrella Baxter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588316749 PECOS PAC ID: 2567835176 Enrollment ID: I20230301003056 |
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