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NPI Code Detail

MEDICARE: CMS JACKSONVILLE

MEDICARE: CMS JACKSONVILLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251K00000XPublic Health or Welfare AgencyFL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093781064
Entity Type Code : Organization
Provider Name (Legal Business Name) : CMS JACKSONVILLE
Provider Business Mailing Address
First Line : 910 NORTH JEFFERSON STREET
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32209-6810
Country : US
Telephone Number : 904-360-7070
Fax Number : 904-798-4568
Provider Business Practice Location Address
First Line : 910 NORTH JEFFERSON STREET
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32209-6810
Country : US
Telephone Number : 904-360-7070
Fax Number : 904-798-4568
Authorized Official
Title or Position : PROGRAM ADMINISTRATOR
Name : MS. CATHY KEATHLEY
Credential :
Telephone Number : 352-334-1394
Provider Enumeration Date : 02/28/2006
Last Update Date : 08/14/2007

Similar Medicare Providers

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Practice Location Address:
910 N JEFFERSON ST
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32209-6810
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1952263485 — KALEELAH SCOTT
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1851253389 — EBONY HURLEY
Practice Location Address:
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Practice Fax:
1538129002 — MANAGED ACCESS TO CHILD HEALTH INC
Practice Location Address:
910 N JEFFERSON ST
JACKSONVILLE, FL
32209-6810
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1700847001 — DR. MA. CONCEPCION MENDOZA PRUDENCIO MD
Practice Location Address:
910 N JEFFERSON ST
JACKSONVILLE, FL
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Practice Phone: 904-359-3842
Practice Fax: 904-359-3847
1598717761 — DR. MARLENE S GOODFRIEND MD
Practice Location Address:
910 N JEFFERSON ST
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32209-6810
Practice Phone: 904-359-3842
Practice Fax: 904-359-3847

Directions to “CMS JACKSONVILLE ” Practice Location

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