| First Coast Ltc, Inc | |
|
25 State Road 13 Att: Clinic Saint Johns FL 32259-2842 | |
| (904) 309-6504 | |
| (904) 503-3577 |
| Full Name | First Coast Ltc, Inc |
|---|---|
| Speciality | General Practice |
| Location | 25 State Road 13, Saint Johns, Florida |
| Authorized Official Name and Position | David Samara (PRESIDENT) |
| Authorized Official Contact | 9043096504 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| 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 25 State Road 13 Att: Clinic Saint Johns FL 32259-2842 Ph: (904) 309-6504 |
| NPI Number | 1538418868 |
|---|---|
| Provider Enumeration Date | 08/31/2012 |
| Last Update Date | 03/07/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538418868 | NPI | - | NPPES |
| 371340700 | Medicaid | FL | |
| CG-1814 | Other | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ME31637 (Florida) | Primary |
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