| |
1522 Emerson St Jacksonville FL 32207-6102 | |
(904) 396-3964 | |
Not Available |
Full Name | |
---|---|
Speciality | Pediatrics |
Location | 1522 Emerson St, Jacksonville, Florida |
Authorized Official Name and Position | John M Assi (OWNER) |
Authorized Official Contact | 9043981471 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
3710 Grandy Ave Jacksonville FL 32207-6112 Ph: (904) 398-1471 | 1522 Emerson St Jacksonville FL 32207-6102 Ph: (904) 396-3964 |
NPI Number | 1619184520 |
---|---|
Provider Enumeration Date | 05/17/2007 |
Last Update Date | 04/23/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619184520 | NPI | - | NPPES |
271710700 | Medicaid | FL | |
263972604 | Medicaid | FL | |
263972605 | Medicaid | FL | |
273550400 | Medicaid | FL | |
271799900 | Medicaid | FL | |
261957100 | Medicaid | FL | |
263972606 | Medicaid | FL | |
049478000 | Medicaid | FL | |
263972600 | Medicaid | FL | |
263972601 | Medicaid | FL | |
263972602 | Medicaid | FL | |
264779600 | Medicaid | FL | |
270050600 | Medicaid | FL | |
277454200 | Medicaid | FL | |
000802100 | Medicaid | FL | |
263972603 | Medicaid | FL | |
270738100 | Medicaid | FL | |
274771500 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
208000000X | Pediatrics | (* (Not Available)) | Primary |
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