Provider Demographics
NPI:1003925728
Name:KIELY, JEREMIAH, & BARBERIS, PA
Entity Type:Organization
Organization Name:KIELY, JEREMIAH, & BARBERIS, PA
Other - Org Name:LAKEWOOD ACUTE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRENCH
Authorized Official - Last Name:KIELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-737-8686
Mailing Address - Street 1:5978 POWERS AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2210
Mailing Address - Country:US
Mailing Address - Phone:904-737-8686
Mailing Address - Fax:904-448-5414
Practice Address - Street 1:5978 POWERS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2210
Practice Address - Country:US
Practice Address - Phone:904-737-8686
Practice Address - Fax:904-448-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39469146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25127Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER