Provider Demographics
NPI:1063454858
Name:PHYSICIANS MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-262-9444
Mailing Address - Street 1:9826 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5438
Mailing Address - Country:US
Mailing Address - Phone:904-262-9444
Mailing Address - Fax:904-262-3750
Practice Address - Street 1:9826 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5438
Practice Address - Country:US
Practice Address - Phone:904-262-9444
Practice Address - Fax:904-262-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593466707OtherCHIRO ALLIANCE
FL88269OtherBLUE CROSS BLUE SHIELD