| Id Consults And Services, Pa | |
|
3142 Northside Dr Suite 101 Key West FL 33040-8012 | |
| (305) 615-3300 | |
| Not Available |
| Full Name | Id Consults And Services, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 3142 Northside Dr, Key West, Florida |
| Authorized Official Name and Position | Darryl Wallace (BUSINESS MANAGER) |
| Authorized Official Contact | 7709775056 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Id Consults And Services, Pa 3142 Northside Dr Suite 101 Key West FL 33040-8012 Ph: (305) 615-3300 | Id Consults And Services, Pa 3142 Northside Dr Suite 101 Key West FL 33040-8012 Ph: (305) 615-3300 |
| NPI Number | 1043551468 |
|---|---|
| Provider Enumeration Date | 03/11/2013 |
| Last Update Date | 10/17/2013 |
| Medicare PECOS PAC ID | 1759528623 |
|---|---|
| Medicare Enrollment ID | O20130513000548 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043551468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | ME 114239 (Florida) | Primary |
| Provider Name | Jerry J Jackson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881874584 PECOS PAC ID: 5991992661 Enrollment ID: I20121226000029 |
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