MEDICARE: UNIVERSITY CLINIC

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	208600000X	Surgery Physician	06776	FL

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	:	1164655767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 56164
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32241-6164
Country	:	US
Telephone Number	:	904-367-8686
Fax Number	:

Provider Business Practice Location Address
First Line	:	2535 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2003
Country	:	US
Telephone Number	:	904-367-8686
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CARMEN DAMASCO
Credential	:
Telephone Number	:	904-367-8686

Provider Enumeration Date	:	08/29/2009
Last Update Date	:	08/29/2009

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Directions to “UNIVERSITY CLINIC ” Practice Location

Language	Start Address	Practice Location

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