| First Coast Ltc Inc | |
|
6555 Chester Ave Ste 1 Jacksonville FL 32217-2279 | |
| (904) 309-6504 | |
| (904) 503-3577 |
| Full Name | First Coast Ltc Inc |
|---|---|
| Speciality | General Practice |
| Location | 6555 Chester Ave Ste 1, Jacksonville, Florida |
| Authorized Official Name and Position | David J Samara (PRESIDENT) |
| Authorized Official Contact | 9043096504 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First Coast Ltc Inc 6555 Chester Ave Ste 1 Jacksonville FL 32217-2279 Ph: (904) 309-6504 | First Coast Ltc Inc 6555 Chester Ave Ste 1 Jacksonville FL 32217-2279 Ph: (904) 309-6504 |
| NPI Number | 1932136314 |
|---|---|
| Provider Enumeration Date | 06/28/2006 |
| Last Update Date | 03/07/2016 |
| Medicare PECOS PAC ID | 9234037896 |
|---|---|
| Medicare Enrollment ID | O20031222000213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932136314 | NPI | - | NPPES |
| CG-1814 | Other | RAILROAD MEDICARE | |
| 371340700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Karim Samara |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1700844420 PECOS PAC ID: 5698773356 Enrollment ID: I20061114000096 |
| Provider Name | David Samara |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1679513477 PECOS PAC ID: 9032017694 Enrollment ID: I20100108000542 |
| Provider Name | Andrea Bastillo Higgins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235643057 PECOS PAC ID: 4486914926 Enrollment ID: I20180201001689 |
| Provider Name | Cynthia Priscilla Quinones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932604063 PECOS PAC ID: 9234481318 Enrollment ID: I20181018000691 |
| Provider Name | Grace A Herrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639767478 PECOS PAC ID: 8426462607 Enrollment ID: I20210129000584 |
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