MEDICARE: BEACHES NEUROLOGY CLINIC

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45912	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1932146875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACHES NEUROLOGY CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 17809
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-7809
Country	:	US
Telephone Number	:	904-723-5665
Fax Number	:	904-338-0951

Provider Business Practice Location Address
First Line	:	1370 13TH AVE S STE 215
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3206
Country	:	US
Telephone Number	:	904-249-1041
Fax Number	:	904-249-9764

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS SNYDER
Credential	:	MD
Telephone Number	:	904-249-1041

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	11/20/2007

Similar Medicare Providers

1770016800 — DR. MICHAEL S TODINCA M.D.
Practice Location Address:

1370 13TH AVE S STE 215
JACKSONVILLE BEACH, FL
32250-3206

Practice Phone: 904-249-1041
Practice Fax: 904-249-9764

1750378311 — THOMAS M SNYDER MD
Practice Location Address:

1370 13TH AVE S STE 215
JACKSONVILLE BEACH, FL
32250-3206

Practice Phone: 904-249-1041
Practice Fax: 904-249-9764

1255328860 — DR. KAREN K THALINGER MD
Practice Location Address:

1370 13TH AVE S STE 215
JACKSONVILLE BEACH, FL
32250-3206

Practice Phone: 904-249-1041
Practice Fax: 904-249-9764

1841251949 — SAMUEL A. CHRISTIAN M.D.
Practice Location Address:

1370 13TH AVENUE, SOUTH , SUITE 118
JACKSONVILLE BEACH, FL
32250-3206

Practice Phone: 904-247-1456
Practice Fax: 904-247-2281

1497713614 — DR. AGNES G. DAVID M. D.
Practice Location Address:

1370 13TH AVENUE , SUITE 119
JACKSONVILLE BEACH, FL
32250-3206

Practice Phone: 904-249-4994
Practice Fax: 904-249-2604

1558307660 — DR. THOMAS ROBERT AUSTGEN MD
Practice Location Address:

1370 13TH AVE S , SUITE 116
JACKSONVILLE BEACH, FL
32250-3206

Practice Phone: 904-247-3858
Practice Fax: 904-247-7079

Directions to “BEACHES NEUROLOGY CLINIC ” Practice Location

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