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PHYSICIAN ASSOCIATES OF JACKSONVILLE PA NPI 1750448163


NPI Information

NPI: 1750448163
Provider Name: PHYSICIAN ASSOCIATES OF JACKSONVILLE, PA
Classification: Internal Medicine - 207RG0300X
Entity Type: Organization

Specialization: Geriatric Medicine

CLIA Number: 10D1004198

Address:
2700 RIVERSIDE AVENUE
SUITE#14
JACKSONVILLE, FL
ZIP 32205
Phone: (904) 389-3770
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PHYSICIAN ASSOCIATES OF JACKSONVILLE, PA is a geriatric medicine internal medicine in Jacksonville, FL. The provider is an internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. PHYSICIAN ASSOCIATES OF JACKSONVILLE, PA NPI is 1750448163. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2700 RIVERSIDE AVENUE
SUITE#14
JACKSONVILLE, FL
ZIP 32205
Phone: (904) 389-3770
Fax: (904) 389-3703

The provider's authorized official is Nag Ravichandran .
The authorized official title is Administrator and has the following contact phone number (904) 389-3770.

The CLIA number assigned to this NPI record is 10D1004198 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/3/2007 and was last updated on 2/6/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RG0300XInternal MedicineGeriatric MedicineME741014FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1K1498MEDICARE PINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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