MEDICARE: SECURE MEDICAL STAFFING 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	171W00000X	Contractor

General Provider Information

NPI Number	:	1356994446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURE MEDICAL STAFFING INC.

Provider Business Mailing Address
First Line	:	25 N MARKET ST STE 241
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2802
Country	:	US
Telephone Number	:	904-803-8358
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 N MARKET ST STE 241
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2802
Country	:	US
Telephone Number	:	904-803-8358
Fax Number	:	888-676-4449

Authorized Official
Title or Position	:	OWNER
Name	:	YOLANDA GRIMES
Credential	:
Telephone Number	:	904-803-8358

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	07/18/2019

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