MEDICARE: JACKSONVILLE INTERNAL MEDICINE

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	207R00000X	Internal Medicine Physician	25404	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01D1017203	OTHER	AL	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811066103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSONVILLE INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	PO BOX 550
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265
Country	:	US
Telephone Number	:	256-435-5499
Fax Number	:	256-435-6064

Provider Business Practice Location Address
First Line	:	2270 PELHAM RD S
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-9582
Country	:	US
Telephone Number	:	256-435-5499
Fax Number	:	256-435-6064

Authorized Official
Title or Position	:	OWNER
Name	:	DR. REY GAVINO
Credential	:
Telephone Number	:	256-435-5499

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	01/11/2012

Similar Medicare Providers

1114879434 — KRYSTIN PAIGE CUTHRELL LPC
Practice Location Address:

203 MACON DR SE
JACKSONVILLE, AL
36265-2645

Practice Phone: 256-454-3223
Practice Fax:

1063418200 — MR. FRANK A BROWN CRNA
Practice Location Address:

1210 JACKSONS WAY SW
JACKSONVILLE, AL
36265-4305

Practice Phone: 256-435-6999
Practice Fax: 256-435-6999

1730188673 — CITY OF JACKSONVILLE
Practice Location Address:

506 CHINABEE AVE SE
JACKSONVILLE, AL
36265-2881

Practice Phone: 256-435-7611
Practice Fax: 256-435-4103

1639163397 — RUSSELL LEON INGRAM M.D.
Practice Location Address:

1460 2ND AVE SW
JACKSONVILLE, AL
36265-3358

Practice Phone: 256-435-2180
Practice Fax: 256-435-9525

1699769174 — JAMES RICHARD YATES M.D.
Practice Location Address:

1460 2ND AVE SW
JACKSONVILLE, AL
36265-3358

Practice Phone: 256-435-2180
Practice Fax: 256-435-9525

1629064118 — DR. LAWRENCE S ROSEN MD
Practice Location Address:

201 HENRY RD SW
JACKSONVILLE, AL
36265-3324

Practice Phone: 256-435-1871
Practice Fax: 256-435-5703

Directions to “JACKSONVILLE INTERNAL MEDICINE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.