Provider Demographics
NPI:1093044166
Name:JACKSONVILLE EMERGENCY MEDICINE LLC
Entity Type:Organization
Organization Name:JACKSONVILLE EMERGENCY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-256-0724
Mailing Address - Street 1:PO BOX 11457
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-1457
Mailing Address - Country:US
Mailing Address - Phone:386-274-7800
Mailing Address - Fax:386-274-7801
Practice Address - Street 1:1400 BRADEN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3721
Practice Address - Country:US
Practice Address - Phone:501-985-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty