| Jax Visiting Medical Providers Llc | |
|
9957 Moorings Dr 204 Jacksonville FL 32257-2412 | |
| (904) 513-4947 | |
| (904) 513-4948 |
| Full Name | Jax Visiting Medical Providers Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 9957 Moorings Dr, Jacksonville, Florida |
| Authorized Official Name and Position | Lilian P Obrero-gines (PHYSICIAN) |
| Authorized Official Contact | 9045134947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jax Visiting Medical Providers Llc 1600 Sheffield Park Ct Jacksonville FL 32225-2667 Ph: (904) 382-2608 | Jax Visiting Medical Providers Llc 9957 Moorings Dr 204 Jacksonville FL 32257-2412 Ph: (904) 513-4947 |
| NPI Number | 1679931372 |
|---|---|
| Provider Enumeration Date | 02/09/2016 |
| Last Update Date | 02/09/2016 |
| Medicare PECOS PAC ID | 7113224437 |
|---|---|
| Medicare Enrollment ID | O20160330002680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679931372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Lilian P Gines |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770630709 PECOS PAC ID: 1850553850 Enrollment ID: I20120509000421 |
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