MEDICARE: FIRST COAST MEDICAL CENTER 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1134157217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST COAST MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 17809
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-7809
Country	:	US
Telephone Number	:	904-723-0015
Fax Number	:	904-338-0951

Provider Business Practice Location Address
First Line	:	4211 N PEARL ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-6411
Country	:	US
Telephone Number	:	904-358-8692
Fax Number	:	904-354-6908

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DIANA WHEELER
Credential	:
Telephone Number	:	904-723-5665

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	02/07/2014

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