| Saint Augustine Hospitalists Primary Care | |
|
1000 Plantation Island Dr S Ste 9 St Augustine FL 32080-3106 | |
| (904) 460-9191 | |
| (904) 471-4859 |
| Full Name | Saint Augustine Hospitalists Primary Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 1000 Plantation Island Dr S Ste 9, St Augustine, Florida |
| Authorized Official Name and Position | Jawad Samir Farhat (OWNER) |
| Authorized Official Contact | 9044609191 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Saint Augustine Hospitalists Primary Care Po Box 3123 St Augustine FL 32085-3123 Ph: () - | Saint Augustine Hospitalists Primary Care 1000 Plantation Island Dr S Ste 9 St Augustine FL 32080-3106 Ph: (904) 460-9191 |
| NPI Number | 1962977306 |
|---|---|
| Provider Enumeration Date | 10/12/2018 |
| Last Update Date | 11/08/2024 |
| Medicare PECOS PAC ID | 1355687419 |
|---|---|
| Medicare Enrollment ID | O20190109003499 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962977306 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jawad S Farhat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114034709 PECOS PAC ID: 1153315551 Enrollment ID: I20040408001606 |
| Provider Name | Gwendolyn Marie Spong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568954576 PECOS PAC ID: 0446596191 Enrollment ID: I20190116003605 |
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