MEDICARE: FLAGLER PROFESSIONAL HEALTH CARE SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1033763487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLAGLER PROFESSIONAL HEALTH CARE SERVICES INC.

Provider Business Mailing Address
First Line	:	PO BOX 3266
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32085-3266
Country	:	US
Telephone Number	:	904-819-4602
Fax Number	:	904-819-4426

Provider Business Practice Location Address
First Line	:	300 HEALTH PARK BLVD STE 5002
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-3705
Country	:	US
Telephone Number	:	904-819-5861
Fax Number	:	904-819-5862

Authorized Official
Title or Position	:	AO
Name	:	JASON PAUL BARRETT
Credential	:
Telephone Number	:	904-819-4400

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	07/31/2020

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