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General NPI Number Information
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NPI Number | 1164519070
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE CHILDREN'S AND MULTISPECIALTY CLINIC, PA
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 118 MEMORIAL DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6328
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Country | US
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Telephone | 910-353-0581
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Fax | 910-353-1351
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Provider Business Mailing Address
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Address Line | PO BOX 986513 DEPARTMENT 100
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City | BOSTON
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State | MA
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Zip | 02298-6513
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Country | US
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Telephone | 910-219-8326
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Fax | 910-939-4269
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MADHUR MITTAL
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Credential | MD
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Telephone | 910-353-0581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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