MEDICARE: MEDICAL ASSOCIATES OF NORTH FLORIDA, 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	146N00000X	Basic Emergency Medical Technician	EMT 300287	FL
2	163W00000X	Registered Nurse	RN 9182095	FL
3	246Z00000X	Other Specialist/Technologist	AL 377	FL
4	367500000X	Certified Registered Nurse Anesthetist		FL
5	208VP0014X	Interventional Pain Medicine Physician	ME 80275	FL

General Provider Information

NPI Number	:	1801021787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL ASSOCIATES OF NORTH FLORIDA, INC.

Provider Business Mailing Address
First Line	:	3948 3RD ST S
Second Line	:	SUITE 1320
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5847
Country	:	US
Telephone Number	:	904-328-2238
Fax Number	:	904-212-1719

Provider Business Practice Location Address
First Line	:	3948 3RD ST S
Second Line	:	SUITE 1320
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5847
Country	:	US
Telephone Number	:	904-328-2238
Fax Number	:	904-212-1719

Authorized Official
Title or Position	:	CEO
Name	:	DR. DOUGLAS MICHAEL KLEINER
Credential	:	PHD
Telephone Number	:	904-328-2238

Provider Enumeration Date	:	05/21/2009
Last Update Date	:	05/21/2009

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