Healthcare Provider Details

I. General information

NPI: 1255859641
Provider Name (Legal Business Name): MCGOWAN MEDICAL CENTERS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 N MAIN ST
JACKSONVILLE FL
32206-2122
US

IV. Provider business mailing address

3021 N MAIN ST
JACKSONVILLE FL
32206-2122
US

V. Phone/Fax

Practice location:
  • Phone: 904-350-5544
  • Fax: 904-350-9944
Mailing address:
  • Phone: 904-350-5544
  • Fax: 904-350-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ROYCE MCGOWAN
Title or Position: PRESIDENT
Credential:
Phone: 904-350-5544