| Coastal Plus Medical Center Inc | |
|
11761 Beach Blvd Suite 8 Jacksonville FL 32246-6615 | |
| (904) 642-3304 | |
| (904) 642-8375 |
| Full Name | Coastal Plus Medical Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11761 Beach Blvd, Jacksonville, Florida |
| Authorized Official Name and Position | Carmen D Riza (OWNER) |
| Authorized Official Contact | 9046423304 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Plus Medical Center Inc 11761 Beach Blvd Suite 8 Jacksonville FL 32246-6615 Ph: (904) 642-3304 | Coastal Plus Medical Center Inc 11761 Beach Blvd Suite 8 Jacksonville FL 32246-6615 Ph: (904) 642-3304 |
| NPI Number | 1407172018 |
|---|---|
| Provider Enumeration Date | 04/08/2010 |
| Last Update Date | 12/16/2019 |
| Medicare PECOS PAC ID | 1153693577 |
|---|---|
| Medicare Enrollment ID | O20170821001064 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407172018 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | George M Young |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245265677 PECOS PAC ID: 0547155053 Enrollment ID: I20051203000030 |
| Provider Name | Clint D Miller |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1467403824 PECOS PAC ID: 8224091046 Enrollment ID: I20071228000011 |
| Provider Name | Richard Bloom |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1548298250 PECOS PAC ID: 8426095217 Enrollment ID: I20081211000194 |
| Provider Name | Randy L John |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1316140817 PECOS PAC ID: 8628067774 Enrollment ID: I20091216000622 |
| Provider Name | Loren Douglas Thornton |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1881767341 PECOS PAC ID: 6709024912 Enrollment ID: I20130530000115 |
| Provider Name | Carmen D Riza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134505472 PECOS PAC ID: 7113218140 Enrollment ID: I20160622002709 |
| Provider Name | Ramon Ruiz Rivera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447310685 PECOS PAC ID: 4789802471 Enrollment ID: I20180409000734 |
| Provider Name | Lyla Marie Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508470527 PECOS PAC ID: 5092199455 Enrollment ID: I20220902000493 |
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