MEDICARE: ER COMPANION LLC

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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1518784321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ER COMPANION LLC

Provider Business Mailing Address
First Line	:	1526 W 19TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-4914
Country	:	US
Telephone Number	:	904-290-9476
Fax Number	:

Provider Business Practice Location Address
First Line	:	1526 W 19TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-4914
Country	:	US
Telephone Number	:	904-290-9476
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DECINTHIES SUTHERLAND
Credential	:
Telephone Number	:	904-290-9476

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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Directions to “ER COMPANION LLC ” Practice Location

Language	Start Address	Practice Location

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