MEDICARE: MCCRAY MEDICAL CARE

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	247ZC0005X	Clinical Laboratory Director (Non-physician)

General Provider Information

NPI Number	:	1881475119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCRAY MEDICAL CARE

Provider Business Mailing Address
First Line	:	2150 SOUTEL DR # 12
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2281
Country	:	US
Telephone Number	:	904-434-6875
Fax Number	:	904-467-3297

Provider Business Practice Location Address
First Line	:	2150 SOUTEL DR # 12
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2281
Country	:	US
Telephone Number	:	904-434-6875
Fax Number	:	904-467-3297

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY ROSS MCCRAY
Credential	:
Telephone Number	:	904-434-6875

Provider Enumeration Date	:	10/12/2023
Last Update Date	:	10/12/2023

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