Provider Demographics
NPI:1053838946
Name:ACE MEDICAL LLC
Entity Type:Organization
Organization Name:ACE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-238-3752
Mailing Address - Street 1:9471 BAYMEADOWS RD STE 405
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7937
Mailing Address - Country:US
Mailing Address - Phone:904-238-3752
Mailing Address - Fax:904-513-9250
Practice Address - Street 1:112 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4819
Practice Address - Country:US
Practice Address - Phone:904-475-2039
Practice Address - Fax:904-330-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7635710001OtherNSC