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NPI Code Detail

MEDICARE: COGENT HEALTHCARE OF JACKSONVILLE, LLC

MEDICARE: COGENT HEALTHCARE OF 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
1207R00000XInternal Medicine Physician

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 : 1548843717
Entity Type Code : Organization
Provider Name (Legal Business Name) : COGENT HEALTHCARE OF JACKSONVILLE, LLC
Provider Business Mailing Address
First Line : 5410 MARYLAND WAY STE 300
Second Line :
City : BRENTWOOD
State : TN
Zip : 37027-5339
Country : US
Telephone Number : 615-577-6340
Fax Number :
Provider Business Practice Location Address
First Line : 2701 N COURSE DR
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33069-3058
Country : US
Telephone Number : 954-975-8900
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MELISSA HARLAN
Credential :
Telephone Number : 615-577-6340
Provider Enumeration Date : 05/04/2021
Last Update Date : 05/04/2021

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