| Clay Primary & Family Care Llc | |
|
865 Blanding Blvd Orange Park FL 32065-8917 | |
| (904) 276-1133 | |
| (904) 276-1821 |
| Full Name | Clay Primary & Family Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 865 Blanding Blvd, Orange Park, Florida |
| Authorized Official Name and Position | Massoud Moshiree (PRESIDENT/OWNER) |
| Authorized Official Contact | 9042761133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clay Primary & Family Care Llc 865 Blanding Blvd Orange Park FL 32065-8917 Ph: (904) 276-1133 | Clay Primary & Family Care Llc 865 Blanding Blvd Orange Park FL 32065-8917 Ph: (904) 276-1133 |
| NPI Number | 1730186792 |
|---|---|
| Provider Enumeration Date | 07/06/2005 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 0840196176 |
|---|---|
| Medicare Enrollment ID | O20031209000287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730186792 | NPI | - | NPPES |
| 255561100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Florida) | Primary |
| Provider Name | Beethoven T Ruedas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346247418 PECOS PAC ID: 6305938176 Enrollment ID: I20070824000144 |
| Provider Name | Massoud Moshiree |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1598762650 PECOS PAC ID: 8527964857 Enrollment ID: I20100927001445 |
| Provider Name | Jessie A Cirolia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548503105 PECOS PAC ID: 9931343688 Enrollment ID: I20130918000717 |
| Provider Name | Kiona C Pritchard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932342672 PECOS PAC ID: 4688990005 Enrollment ID: I20150303000071 |
| Provider Name | David Anthony Koutz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891176384 PECOS PAC ID: 8820303613 Enrollment ID: I20150824001440 |
| Provider Name | Sarah L Wheeler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619306156 PECOS PAC ID: 4385954619 Enrollment ID: I20151117000397 |
| Provider Name | Ali R Afshar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083901177 PECOS PAC ID: 8325320104 Enrollment ID: I20170131002832 |
| Provider Name | Jessica Lynn Kalarovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225526239 PECOS PAC ID: 2860742269 Enrollment ID: I20180905003872 |
| Provider Name | Kimberly C Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902391139 PECOS PAC ID: 2668726787 Enrollment ID: I20181108000532 |
| Provider Name | Marissa Manansala Aranzaso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730684655 PECOS PAC ID: 9739411224 Enrollment ID: I20191104000156 |
| Provider Name | Christelle Takou Oben |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821341801 PECOS PAC ID: 6608266770 Enrollment ID: I20211203000577 |
| Provider Name | Meinrado Pontejos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184209249 PECOS PAC ID: 7911394028 Enrollment ID: I20220420000040 |
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