MEDICARE: ALL WOMEN'S HEALTH CENTER 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
1	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1790447977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL WOMEN'S HEALTH CENTER OF JACKSONVILLE, INC

Provider Business Mailing Address
First Line	:	2106 DREW STREET
Second Line	:	SUITE 103
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3238
Country	:	US
Telephone Number	:	727-442-0445
Fax Number	:	727-447-3797

Provider Business Practice Location Address
First Line	:	1545 HUFFINGHAM ROAD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2721
Country	:	US
Telephone Number	:	904-731-2755
Fax Number	:	904-730-7376

Authorized Official
Title or Position	:	INSURANCE BILLING REPRESENTATIVE
Name	:	VICKI RAMBO
Credential	:
Telephone Number	:	727-442-0445

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	10/06/2021

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