MEDICARE: JACKSONVILLE CHILDREN'S AND MULTISPECIALTY CLINIC, PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RG0100X	Gastroenterology Physician
2	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician
3	2080N0001X	Neonatal-Perinatal Medicine Physician
4	207R00000X	Internal Medicine Physician
5	208000000X	Pediatrics Physician
6	2080P0202X	Pediatric Cardiology Physician
7	207KA0200X	Allergy Physician
8	207Q00000X	Family Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1164519070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSONVILLE CHILDREN'S AND MULTISPECIALTY CLINIC, PA

Provider Business Mailing Address
First Line	:	PO BOX 986513
Second Line	:	DEPARTMENT 100
City	:	BOSTON
State	:	MA
Zip	:	02298-6513
Country	:	US
Telephone Number	:	910-219-8326
Fax Number	:	910-939-4269

Provider Business Practice Location Address
First Line	:	118 MEMORIAL DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6328
Country	:	US
Telephone Number	:	910-353-0581
Fax Number	:	910-353-1351

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MADHUR MITTAL
Credential	:	MD
Telephone Number	:	910-353-0581

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	01/12/2026

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