Provider Demographics
NPI:1275704710
Name:JAX'S FAMILY CARE AND RESEARCH CENTER, P.A.
Entity Type:Organization
Organization Name:JAX'S FAMILY CARE AND RESEARCH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAIRO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:DELAHOZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:904-800-2332
Mailing Address - Street 1:5233 RICKER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1439
Mailing Address - Country:US
Mailing Address - Phone:904-800-2332
Mailing Address - Fax:904-634-7892
Practice Address - Street 1:5233 RICKER RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210
Practice Address - Country:US
Practice Address - Phone:904-800-2332
Practice Address - Fax:904-634-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70797261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251739600Medicaid
FLG36956Medicare UPIN