MEDICARE: JACKSONVILLE ORTHOPAEDIC INSTITUTE INC

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
1	207X00000X	Orthopaedic Surgery Physician		FL

General Provider Information

NPI Number	:	1134224108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSONVILLE ORTHOPAEDIC INSTITUTE INC

Provider Business Mailing Address
First Line	:	PO BOX 117345
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-7345
Country	:	US
Telephone Number	:	904-346-3465
Fax Number	:	904-858-6489

Provider Business Practice Location Address
First Line	:	1845 TOWN CENTER BLVD
Second Line	:	SUITE 405
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-3356
Country	:	US
Telephone Number	:	904-276-5776
Fax Number	:	904-276-5958

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOHN J RICCHINI
Credential	:
Telephone Number	:	904-346-3465

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	01/08/2019

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