MEDICARE: ARA-WEST JACKSONVILLE LLC

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093730806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARA-WEST JACKSONVILLE LLC

Provider Business Mailing Address
First Line	:	425 N LEE ST
Second Line	:	SUITE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-1128
Country	:	US
Telephone Number	:	904-598-2711
Fax Number	:	904-598-2712

Provider Business Practice Location Address
First Line	:	425 N LEE ST
Second Line	:	SUITE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-1128
Country	:	US
Telephone Number	:	904-598-2711
Fax Number	:	904-598-2712

Authorized Official
Title or Position	:	CHIEF NURSING OFFICER
Name	:	SARA ANNE BRADY
Credential	:
Telephone Number	:	208-371-7878

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	01/10/2023

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Directions to “ARA-WEST JACKSONVILLE LLC ” Practice Location

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