Provider Demographics
NPI:1235286527
Name:HYDE PARK MEDICAL ARTS INC
Entity Type:Organization
Organization Name:HYDE PARK MEDICAL ARTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-783-3700
Mailing Address - Street 1:6671 HYDE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2839
Mailing Address - Country:US
Mailing Address - Phone:904-783-3700
Mailing Address - Fax:904-695-2579
Practice Address - Street 1:6671 HYDE GROVE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2839
Practice Address - Country:US
Practice Address - Phone:904-783-3700
Practice Address - Fax:904-695-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7282207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264729000Medicaid
FL264729000Medicaid