Issa.med P.a. | |
2 Pavillion Place Penney Farms FL 32079 | |
(217) 416-6431 | |
Not Available |
Full Name | Issa.med P.a. |
---|---|
Speciality | Internal Medicine |
Location | 2 Pavillion Place, Penney Farms, Florida |
Authorized Official Name and Position | Hani Issa (PRESIDENT) |
Authorized Official Contact | 2174166431 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Issa.med P.a. 1907 Atlantic Blvd Ste 1 Jacksonville FL 32207-3405 Ph: () - | Issa.med P.a. 2 Pavillion Place Penney Farms FL 32079 Ph: (217) 416-6431 |
NPI Number | 1376217364 |
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Provider Enumeration Date | 08/04/2021 |
Last Update Date | 08/04/2021 |
Medicare PECOS PAC ID | 8628472537 |
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Medicare Enrollment ID | O20210813000780 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376217364 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
Provider Name | Hani Issa |
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Provider Type | Practitioner - Geriatric Medicine |
Provider Identifiers | NPI Number: 1619144045 PECOS PAC ID: 2668621236 Enrollment ID: I20170928001398 |
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