| Lighthouse Internal Medicine And Primary Care Pa | |
|
5757 Booth Rd. #200 Jacksonville FL 32207 | |
| (904) 636-9510 | |
| (904) 636-9512 |
| Full Name | Lighthouse Internal Medicine And Primary Care Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 5757 Booth Rd., Jacksonville, Florida |
| Authorized Official Name and Position | Chonglun Xie (MD) |
| Authorized Official Contact | 9046369510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Internal Medicine And Primary Care Pa 5757 Booth Rd Bldg 200 Jacksonville FL 32207-5981 Ph: (904) 636-9510 | Lighthouse Internal Medicine And Primary Care Pa 5757 Booth Rd. #200 Jacksonville FL 32207 Ph: (904) 636-9510 |
| NPI Number | 1588742977 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 09/21/2018 |
| Medicare PECOS PAC ID | 9234232224 |
|---|---|
| Medicare Enrollment ID | O20070313000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588742977 | NPI | - | NPPES |
| 009831900 | Medicaid | FL | |
| 40311 | Other | FL | BCBS FL |
| 273938100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME92689 (Florida) | Primary |
| Provider Name | Chonglun Xie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861457459 PECOS PAC ID: 3577590314 Enrollment ID: I20050722000544 |
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