Provider Demographics
NPI:1033163738
Name:JACKSONVILLE ANESTHESIA CORPORATION INC
Entity Type:Organization
Organization Name:JACKSONVILLE ANESTHESIA CORPORATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-238-4147
Mailing Address - Street 1:PO BOX 160489
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-0489
Mailing Address - Country:US
Mailing Address - Phone:855-496-3578
Mailing Address - Fax:855-371-8490
Practice Address - Street 1:1350 13TH AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-3203
Practice Address - Country:US
Practice Address - Phone:855-496-3578
Practice Address - Fax:855-371-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268268100Medicaid
FL268268100Medicaid