MEDICARE: JAX EMERGENCY PHYSICIANS, 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	207P00000X	Emergency Medicine 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	:	1992376263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAX EMERGENCY PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	5565 CENTERVIEW DR STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2361 N SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3714
Country	:	US
Telephone Number	:	973-251-1132
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHY KONDAS
Credential	:
Telephone Number	:	973-251-1132

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

Similar Medicare Providers

1669318499 — OVIEDO MEDICAL CENTER, LLC
Practice Location Address:

2361 N SEMORAN BLVD
ORLANDO, FL
32807-3714

Practice Phone: 615-344-9551
Practice Fax:

1306417654 — FL-I MEDICAL SERVICES, LLC
Practice Location Address:

2361 N SEMORAN BLVD
ORLANDO, FL
32807-3714

Practice Phone: 973-251-1132
Practice Fax:

1568113876 — INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC
Practice Location Address:

2361 N SEMORAN BLVD
ORLANDO, FL
32807-3714

Practice Phone: 407-890-2179
Practice Fax:

1174550925 — JORGE MANUEL BALLESTEROS CRNA
Practice Location Address:

3714 S SUMMERLIN AVE
ORLANDO, FL
32806-6902

Practice Phone: 812-240-0977
Practice Fax:

1881365260 — VIVIAN HENKE
Practice Location Address:

3307 KATHLEEN DR
ORLANDO, FL
32810-3714

Practice Phone: 828-335-6511
Practice Fax:

1861337099 — PATRIOTMED OF KANSAS
Practice Location Address:

1160 S SEMORAN BLVD STE C
ORLANDO, FL
32807-1461

Practice Phone: 407-250-5001
Practice Fax:

Directions to “JAX EMERGENCY PHYSICIANS, LLC ” 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.