=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962496273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S. ALI SAFI, M.D. PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2005
-----------------------------------------------------
Last Update Date | 06/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9770 OLD BAYMEADOWS RD #109
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-7909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-564-2700
-----------------------------------------------------
Fax | 904-564-2800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8017 WOODGROVE RD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-7242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-564-2700
-----------------------------------------------------
Fax | 904-564-2800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. SEIED ALI SAFI
-----------------------------------------------------
Credential | MD/ PERDIATRICAN
-----------------------------------------------------
Telephone | 904-564-2700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | ME0054100
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------