MEDICARE: AMERICAN ACCESS CARE 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
1	2085R0204X	Vascular & Interventional Radiology Physician

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	:	1669771168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN ACCESS CARE OF JACKSONVILLE LLC

Provider Business Mailing Address
First Line	:	PO BOX 417273
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-7273
Country	:	US
Telephone Number	:	610-644-8900
Fax Number	:	484-924-0053

Provider Business Practice Location Address
First Line	:	2416 DUNN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4604
Country	:	US
Telephone Number	:	904-353-3664
Fax Number	:	904-353-3858

Authorized Official
Title or Position	:	SR VP/AUTHORIZED OFFICIAL
Name	:	GREGG MILLER
Credential	:	MD
Telephone Number	:	717-515-4048

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	09/22/2025

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