MEDICARE: MED MATCH

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1780029983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED MATCH

Provider Business Mailing Address
First Line	:	6789 SOUTHPOINT PKWY STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6789 SOUTHPOINT PKWY STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8206
Country	:	US
Telephone Number	:	904-803-2305
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DAVID STIFTER
Credential	:
Telephone Number	:	904-803-2305

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	05/02/2013

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Directions to “MED MATCH ” Practice Location

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