| Jacksonville Medical Group, Llc | |
|
1409 Kingsley Ave Suite 9g Orange Park FL 32073-4537 | |
| (904) 637-0037 | |
| (904) 639-6017 |
| Full Name | Jacksonville Medical Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1409 Kingsley Ave, Orange Park, Florida |
| Authorized Official Name and Position | Saman Soleymani (OWNER) |
| Authorized Official Contact | 9049627396 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacksonville Medical Group, Llc 396 N Lombardy Loop Jacksonville FL 32259-5266 Ph: () - | Jacksonville Medical Group, Llc 1409 Kingsley Ave Suite 9g Orange Park FL 32073-4537 Ph: (904) 637-0037 |
| NPI Number | 1619341039 |
|---|---|
| Provider Enumeration Date | 11/23/2015 |
| Last Update Date | 07/20/2016 |
| Medicare PECOS PAC ID | 1254623135 |
|---|---|
| Medicare Enrollment ID | O20160713002168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619341039 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME88018 (ZZ) | Primary |
| Provider Name | Saman Soleymani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942260955 PECOS PAC ID: 8022051416 Enrollment ID: I20050607000365 |
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