Provider Demographics
NPI:1336320753
Name:PHYSICIANS MEDICAL CENTERS-JAX INC
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL CENTERS-JAX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF URGENT CARE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:NORVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-458-1308
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:904-292-2285
Practice Address - Street 1:2020 KINGSLEY AVE STE A
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5139
Practice Address - Country:US
Practice Address - Phone:904-458-1308
Practice Address - Fax:904-458-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9034261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AM102Medicare PIN