Healthcare Provider Details

I. General information

NPI: 1497052633
Provider Name (Legal Business Name): FIRST CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 BAYMEADOWS CIR W SUITE 112
JACKSONVILLE FL
32256-1880
US

IV. Provider business mailing address

9838 OLD BAYMEADOWS RD BOX 386
JACKSONVILLE FL
32256-8101
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-1066
  • Fax: 877-413-4074
Mailing address:
  • Phone: 904-281-1066
  • Fax: 877-413-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP STAATS
Title or Position: PRESIDENT
Credential:
Phone: 904-281-1066