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NPI Code Detail

MEDICARE: FIRST COAST LTC INC

MEDICARE: FIRST COAST LTC 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
1208D00000XGeneral Practice Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CG-1814OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932136314
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIRST COAST LTC INC
Provider Business Mailing Address
First Line : 6555 CHESTER AVE STE 1
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-2279
Country : US
Telephone Number : 904-309-6504
Fax Number : 904-503-3577
Provider Business Practice Location Address
First Line : 6555 CHESTER AVE STE 1
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-2279
Country : US
Telephone Number : 904-309-6504
Fax Number : 904-503-3577
Authorized Official
Title or Position : PRESIDENT
Name : DAVID J SAMARA
Credential : MD
Telephone Number : 904-309-6504
Provider Enumeration Date : 06/28/2006
Last Update Date : 03/07/2016

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Directions to “FIRST COAST LTC INC ” Practice Location

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