| Jacksonville Multispecialty Group, Llc | |
|
3627 University Blvd S Ste 615 Jacksonville FL 32216-7401 | |
| (904) 399-1623 | |
| (904) 399-1624 |
| Full Name | Jacksonville Multispecialty Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3627 University Blvd S Ste 615, Jacksonville, Florida |
| Authorized Official Name and Position | Hernan Robert Chang (PRESIDENT) |
| Authorized Official Contact | 9043991623 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacksonville Multispecialty Group, Llc Po Box 17577 Jacksonville FL 32245-7577 Ph: (904) 399-1623 | Jacksonville Multispecialty Group, Llc 3627 University Blvd S Ste 615 Jacksonville FL 32216-7401 Ph: (904) 399-1623 |
| NPI Number | 1609951938 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 12/01/2023 |
| Medicare PECOS PAC ID | 3476550591 |
|---|---|
| Medicare Enrollment ID | O20061103000102 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609951938 | NPI | - | NPPES |
| 001151900 | Medicaid | FL |
| Provider Name | Hernan R Chang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891720629 PECOS PAC ID: 2163413881 Enrollment ID: I20040525001529 |
| Provider Name | Oscar E Rodas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528002748 PECOS PAC ID: 0143281915 Enrollment ID: I20041026000104 |
| Provider Name | Gil A Cu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558338343 PECOS PAC ID: 5092784603 Enrollment ID: I20050221000066 |
| Provider Name | Mohammad F Taj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720282106 PECOS PAC ID: 5890881486 Enrollment ID: I20090324000654 |
| Provider Name | Fadi R Chalhoub |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568451557 PECOS PAC ID: 8527183474 Enrollment ID: I20100915000489 |
| Provider Name | Eugene Griffin |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1124024310 PECOS PAC ID: 3971791963 Enrollment ID: I20101216000976 |
| Provider Name | Mohammad R Ayoub |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982988440 PECOS PAC ID: 5698996551 Enrollment ID: I20141020000525 |
| Provider Name | Helen S Kirkendall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154779098 PECOS PAC ID: 5294028346 Enrollment ID: I20160727000238 |
| Provider Name | Daniel Alan Rowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902200850 PECOS PAC ID: 2860719945 Enrollment ID: I20160810001006 |
| Provider Name | Chea H Lim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801332747 PECOS PAC ID: 3971889155 Enrollment ID: I20170425000780 |
| Provider Name | Millely Josefina Summers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831689678 PECOS PAC ID: 0749535136 Enrollment ID: I20180627000040 |
| Provider Name | Shelley August Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659879237 PECOS PAC ID: 9335499680 Enrollment ID: I20180906002065 |
| Provider Name | Elizabeth Ann Breza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184081465 PECOS PAC ID: 7012269459 Enrollment ID: I20181011002727 |
| Provider Name | Samantha Ann Lance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407374077 PECOS PAC ID: 3476807694 Enrollment ID: I20181106002943 |
| Provider Name | Divya Lakshmi Seval |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1710272521 PECOS PAC ID: 1850519935 Enrollment ID: I20190709000429 |
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