Provider Demographics
NPI:1184845612
Name:PHYSICIANS RESOURCE NETWORK OF JACKSONVILLE, INC.
Entity Type:Organization
Organization Name:PHYSICIANS RESOURCE NETWORK OF JACKSONVILLE, INC.
Other - Org Name:PHYSICIANS RESOURCE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CARIDAD
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-731-7880
Mailing Address - Street 1:6005 POWERS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2280
Mailing Address - Country:US
Mailing Address - Phone:904-731-7880
Mailing Address - Fax:904-731-7881
Practice Address - Street 1:6005 POWERS AVE STE 105
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2280
Practice Address - Country:US
Practice Address - Phone:904-731-7880
Practice Address - Fax:904-731-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1927332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2543OtherBLUE CROSS & BLUE SHIELD
FL7817417OtherAETNA
FL=========OtherCHILDREN'S MEDICAL SERVIC
FL=========OtherTRICARE STANDARD
FL=========OtherHUMANA
FLM2543OtherBLUE CROSS & BLUE SHIELD