| First Coast Medical Associates Llc | |
|
13241 Bartram Park Blvd Unit 413 Jacksonville FL 32258-5237 | |
| (904) 400-6800 | |
| (904) 400-6801 |
| Full Name | First Coast Medical Associates Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 13241 Bartram Park Blvd Unit 413, Jacksonville, Florida |
| Authorized Official Name and Position | Ravi K Kancha (DOCTO) |
| Authorized Official Contact | 9044006800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First Coast Medical Associates Llc 13241 Bartram Park Blvd Unit 413 Jacksonville FL 32258-5237 Ph: (904) 400-6800 | First Coast Medical Associates Llc 13241 Bartram Park Blvd Unit 413 Jacksonville FL 32258-5237 Ph: (904) 400-6800 |
| NPI Number | 1760881163 |
|---|---|
| Provider Enumeration Date | 08/21/2014 |
| Last Update Date | 11/12/2014 |
| Medicare PECOS PAC ID | 0648593707 |
|---|---|
| Medicare Enrollment ID | O20141220000422 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760881163 | NPI | - | NPPES |
| 277639100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 305R00000X | Preferred Provider Organization | ME98044 (Florida) | Secondary |
| Provider Name | Ravi K Kancha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982730214 PECOS PAC ID: 1355446550 Enrollment ID: I20070417000461 |
| Provider Name | Julian M Bungubung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629453246 PECOS PAC ID: 9830494954 Enrollment ID: I20160226000689 |
| Provider Name | Jessica L Lloyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609289255 PECOS PAC ID: 7214217652 Enrollment ID: I20161201000481 |
| Provider Name | Annamarie Loyola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184117574 PECOS PAC ID: 3870847965 Enrollment ID: I20181107003330 |
| Provider Name | Christina M Franklin |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1891299228 PECOS PAC ID: 6305185802 Enrollment ID: I20190227003141 |
| Provider Name | Bayani M Bunal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144791088 PECOS PAC ID: 4486997335 Enrollment ID: I20190517000145 |
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