MEDICARE: MCGOWAN MEDICAL CENTERS, PA

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1255859641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCGOWAN MEDICAL CENTERS, PA

Provider Business Mailing Address
First Line	:	3021 N MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-2122
Country	:	US
Telephone Number	:	904-350-5544
Fax Number	:	904-350-9944

Provider Business Practice Location Address
First Line	:	3021 N MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-2122
Country	:	US
Telephone Number	:	904-350-5544
Fax Number	:	904-350-9944

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROYCE MCGOWAN
Credential	:
Telephone Number	:	904-350-5544

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	12/13/2024

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