MEDICARE: MONROSE CLINIC ASSOCIATES FOR PSYCHOLOGICAL MEDICINE

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	101YM0800X	Mental Health Counselor	ME0048902	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	081686072	OTHER	FL	TRICARE
2	081686072	OTHER	FL	CHAMPUS
3	4115015	OTHER	FL	AETNA
4	14203	OTHER	FL	BLUE CROSS
5	016627000	OTHER	FL	MAGELLAN
6	05770	OTHER	FL	WELLCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	05770	OTHER	FL	UNITED BEHAVIORAL HEALTH
9	081686072	OTHER	FL	FIRST HEALTH
10	088657	OTHER	FL	VALUE OPTIONS
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902076524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROSE CLINIC ASSOCIATES FOR PSYCHOLOGICAL MEDICINE

Provider Business Mailing Address
First Line	:	3627 UNIVERSITY BLVD S STE 615
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-7401
Country	:	US
Telephone Number	:	904-725-6463
Fax Number	:	904-724-5006

Provider Business Practice Location Address
First Line	:	3627 UNIVERSITY BLVD SOUTH SUITE 615
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2721
Country	:	US
Telephone Number	:	904-725-6463
Fax Number	:	904-724-5006

Authorized Official
Title or Position	:	PSYCHIATRISTS
Name	:	DR. ATUL M SHAH
Credential	:	M.D.
Telephone Number	:	904-725-6463

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	09/17/2013

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