Healthcare Provider Details

I. General information

NPI: 1619013851
Provider Name (Legal Business Name): JACKSONVILLE ORTHOPAEDIC INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SAN MARCO BLVD SUITE 200
JACKSONVILLE FL
32207-8568
US

IV. Provider business mailing address

PO BOX 117345
ATLANTA GA
30368-7345
US

V. Phone/Fax

Practice location:
  • Phone: 904-346-3465
  • Fax: 904-396-0388
Mailing address:
  • Phone: 904-346-3465
  • Fax: 904-858-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN RICCHINI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 904-346-3465