| North Florida Medical Clinic Inc | |
|
1361 13th Ave S Ste 150 Jacksonville Beach FL 32250-3235 | |
| (904) 242-7177 | |
| (904) 242-7162 |
| Full Name | North Florida Medical Clinic Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1361 13th Ave S Ste 150, Jacksonville Beach, Florida |
| Authorized Official Name and Position | Holthaus Kevin (PRESIDENT) |
| Authorized Official Contact | 9042427177 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Florida Medical Clinic Inc Po Box 17809 Jacksonville FL 32245-7809 Ph: (904) 723-0015 | North Florida Medical Clinic Inc 1361 13th Ave S Ste 150 Jacksonville Beach FL 32250-3235 Ph: (904) 242-7177 |
| NPI Number | 1639126907 |
|---|---|
| Provider Enumeration Date | 05/30/2006 |
| Last Update Date | 01/24/2012 |
| Medicare PECOS PAC ID | 7315970688 |
|---|---|
| Medicare Enrollment ID | O20050916000310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639126907 | NPI | - | NPPES |
| 94954 | Other | FL | BCBS |
| 1639126907 | Other | NPI | |
| DD6503 | Other | FL | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME43785 (Florida) | Primary |
| Provider Name | Anthony Vetere |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992785943 PECOS PAC ID: 5890770978 Enrollment ID: I20040622001451 |
| Provider Name | Kevin Holthaus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003893215 PECOS PAC ID: 2860425147 Enrollment ID: I20050917000269 |
| Provider Name | Laura M Triola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073670279 PECOS PAC ID: 4789764994 Enrollment ID: I20071231000010 |
| Provider Name | David Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386616795 PECOS PAC ID: 2769519008 Enrollment ID: I20100419000695 |
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