Provider Demographics
NPI:1003126574
Name:GSW CLINIC, LLC
Entity Type:Organization
Organization Name:GSW CLINIC, LLC
Other - Org Name:PHYSICIAN'S HEALTH CENTER OF JACKSONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIMARY MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-477-4480
Mailing Address - Street 1:PO BOX 47125
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32247-7125
Mailing Address - Country:US
Mailing Address - Phone:904-477-4480
Mailing Address - Fax:
Practice Address - Street 1:3728 PHILLIPS HWY
Practice Address - Street 2:SUITE 13
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9300
Practice Address - Country:US
Practice Address - Phone:904-477-4480
Practice Address - Fax:904-683-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty