MEDICARE: NAVAL HOSPITAL JACKSONVILLE

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	207P00000X	Emergency Medicine Physician	J0352	TX

General Provider Information

NPI Number	:	1265411383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVAL HOSPITAL JACKSONVILLE

Provider Business Mailing Address
First Line	:	2080 CHILD ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5005
Country	:	US
Telephone Number	:	904-542-7787
Fax Number	:	904-542-7651

Provider Business Practice Location Address
First Line	:	2080 CHILD ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5005
Country	:	US
Telephone Number	:	904-542-7787
Fax Number	:	904-542-7651

Authorized Official
Title or Position	:	EXECUTIVE OFFICER
Name	:	DR. ELAINE WAGNER
Credential	:	DENTIST
Telephone Number	:	904-542-7312

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	06/18/2008

Similar Medicare Providers

1194710277 — DR. MARGARET DEGGES ALEXANDER D.D.S.
Practice Location Address:

2080 CHILD ST , NAVAL HOSPITAL JACKSONVILLE
JACKSONVILLE, FL
32214-5005

Practice Phone: 904-542-7540
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1821073362 — WILLIAM K BOTT M.D.
Practice Location Address:

2080 CHILD ST , NAVAL HOSPITAL JACKSONVILLE--ORTHO DEPT
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1649258740 — CHAD MICHAEL THOEMKE PA
Practice Location Address:

2080 CHILD ST
JACKSONVILLE, FL
32214-5005

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1871572180 — DR. MICHAEL ALVIS CLEVELAND PHARMD
Practice Location Address:

2080 CHILD ST , NAVAL HOSPITAL JACKSONVILLE PHARMACY DEPT
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1073592465 — PETER KEENE TRUE M. D.
Practice Location Address:

2080 CHILD ST , U. S. NAVAL HOSPITAL JACKSONVILLE NAS JAX
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1194704593 — DR. LYNN LASHAY BEACH CAPT / MC / USN
Practice Location Address:

2080 CHILD ST , NAVAL HOSPITAL JACKSONVILLE, ATTN: LABORATORY
JACKSONVILLE, FL
32214-5005

Practice Phone: 904-542-7388
Practice Fax: 904-542-7399

Directions to “NAVAL HOSPITAL JACKSONVILLE ” Practice Location

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