MEDICARE: CAREMAX CLINIC 711 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	2084P0800X	Psychiatry Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1609359249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREMAX CLINIC 711 LLC

Provider Business Mailing Address
First Line	:	PO BOX 600365
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32260-0365
Country	:	US
Telephone Number	:	904-289-1254
Fax Number	:	904-202-0036

Provider Business Practice Location Address
First Line	:	2732 TROLLIE LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3833
Country	:	US
Telephone Number	:	904-289-1254
Fax Number	:	904-212-0036

Authorized Official
Title or Position	:	DIRECTOR
Name	:	VIPUL B MAMTORA
Credential	:
Telephone Number	:	904-289-1254

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	12/15/2025

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