Healthcare Provider Details

I. General information

NPI: 1528579034
Provider Name (Legal Business Name): AMBULATORY CARE SPECIALISTS OF JACKSONVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 SOUTHPOINT PKWY
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

2929 ARCH ST STE 1705
PHILADELPHIA PA
19104-2857
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-4106
  • Fax: 904-296-3340
Mailing address:
  • Phone: 215-382-3680
  • Fax: 215-240-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES MCGUCKIN
Title or Position: CEO
Credential: MD
Phone: 215-382-3680