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NPI Code Detail

MEDICARE: BAYMEADOWS PRIMARY CARE, INC.

MEDICARE: BAYMEADOWS PRIMARY CARE, 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
1207R00000XInternal Medicine PhysicianME81517FL
2207Q00000XFamily Medicine PhysicianME71382FL

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 : 1174512701
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAYMEADOWS PRIMARY CARE, INC.
Provider Business Mailing Address
First Line : 10058 BAYMEADOWS RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-7177
Country : US
Telephone Number : 904-636-5400
Fax Number : 904-928-0654
Provider Business Practice Location Address
First Line : 10058 BAYMEADOWS RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-7177
Country : US
Telephone Number : 904-636-5400
Fax Number : 904-928-0654
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR/ CFO
Name : MR. S. AWAIS IMAM
Credential :
Telephone Number : 904-636-5400
Provider Enumeration Date : 10/17/2005
Last Update Date : 03/14/2012

Similar Medicare Providers

1801720321 — BROOKE SCHACHTMAN GRIMES
Practice Location Address:
10058 BAYMEADOWS RD STE B
JACKSONVILLE, FL
32256-7177
Practice Phone: 904-450-8020
Practice Fax:
1891722385 — MR. HUSSAIN S IMAM MD
Practice Location Address:
10058 BAYMEADOWS RD
JACKSONVILLE, FL
32256-7177
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Practice Fax: 904-928-0654
1710912654 — MRS. TALAT IMAM MD
Practice Location Address:
10058 BAYMEADOWS RD
JACKSONVILLE, FL
32256-7177
Practice Phone: 904-636-5400
Practice Fax: 904-928-0654
1982152476 — NATALYA LAIRD ARNP
Practice Location Address:
10058 BAYMEADOWS RD
JACKSONVILLE, FL
32256-7177
Practice Phone: 904-636-5400
Practice Fax: 904-928-0654
1932631645 — MRS. SHIVANI MAHESH PATEL PA-C
Practice Location Address:
10058 BAYMEADOWS RD
JACKSONVILLE, FL
32256-7177
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Practice Fax: 904-928-0654
1487120085 — ERIC THEODORE HUTZEL PA-C
Practice Location Address:
10058 BAYMEADOWS RD
JACKSONVILLE, FL
32256-7177
Practice Phone: 904-636-5400
Practice Fax: 904-928-0654

Directions to “BAYMEADOWS PRIMARY CARE, INC. ” Practice Location

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