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NPI Code Detail

MEDICARE: TEN BROECK JACKSONVILLE LLC

MEDICARE: TEN BROECK 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
1283Q00000XPsychiatric Hospital4011FL

Other Identifiers

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

General Provider Information

NPI Number : 1497758312
Entity Type Code : Organization
Provider Name (Legal Business Name) : TEN BROECK JACKSONVILLE LLC
Provider Business Mailing Address
First Line : 6300 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-2708
Country : US
Telephone Number : 904-724-9202
Fax Number : 904-724-3797
Provider Business Practice Location Address
First Line : 6300 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-2708
Country : US
Telephone Number : 904-724-9202
Fax Number : 904-724-3797
Authorized Official
Title or Position : VICE PRESIDENT OF FINANCE
Name : MR. DAVID CORDDRY
Credential :
Telephone Number : 407-876-2200
Provider Enumeration Date : 05/24/2005
Last Update Date : 05/08/2008

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Directions to “TEN BROECK JACKSONVILLE LLC ” Practice Location

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