MEDICARE: INTERNAL MEDICINE ASSOCIATES OF JACKSONVILLE P A

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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1184614166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE ASSOCIATES OF JACKSONVILLE P A

Provider Business Mailing Address
First Line	:	6320 SAINT AUGUSTINE RD
Second Line	:	UNIT 12
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2800
Country	:	US
Telephone Number	:	904-737-6200
Fax Number	:	904-737-6001

Provider Business Practice Location Address
First Line	:	6320 SAINT AUGUSTINE RD
Second Line	:	UNIT 12
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2800
Country	:	US
Telephone Number	:	904-737-6200
Fax Number	:	904-737-6001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VADIM LEV MADFIS
Credential	:	M.D.
Telephone Number	:	904-737-6200

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	04/14/2009

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