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General NPI Number Information
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NPI Number | 1437042785
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Entity Type | Organization
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Legal Business Name | JACK M MATHENY II, MD, LLC
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 800 ZEAGLER DR STE 400
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City | PALATKA
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State | FL
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Zip | 32177-3827
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Country | US
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Telephone | 386-227-6768
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 330196
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-0196
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Country | US
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Telephone | 386-227-6768
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SATISH RAVI
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Credential |
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Telephone | 386-227-6768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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