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NPI Code Detail

MEDICARE: QHG OF JACKSONVILLE INC

MEDICARE: QHG OF JACKSONVILLE 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
1207P00000XEmergency Medicine Physician
2207R00000XInternal Medicine Physician
3367500000XCertified Registered Nurse Anesthetist
4207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1457458820
Entity Type Code : Organization
Provider Name (Legal Business Name) : QHG OF JACKSONVILLE INC
Provider Business Mailing Address
First Line : 7100 COMMERCE WAY
Second Line : SUITE 180
City : BRENTWOOD
State : TN
Zip : 37027-2829
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1701 PELHAM RD S
Second Line :
City : JACKSONVILLE
State : AL
Zip : 36265-3353
Country : US
Telephone Number : 256-435-4970
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF PROVIDER ENROLLMENT
Name : DEBBIE BREWER
Credential :
Telephone Number : 877-892-9813
Provider Enumeration Date : 09/20/2006
Last Update Date : 02/08/2008

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1841348125 — MARY JENNIFER COFFMAN CRNA
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Directions to “QHG OF JACKSONVILLE INC ” Practice Location

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