Provider Demographics
NPI:1366488421
Name:NORTH FLORIDA CHEST PHYSICIANS PA
Entity Type:Organization
Organization Name:NORTH FLORIDA CHEST PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-354-8200
Mailing Address - Street 1:425 N LEE ST
Mailing Address - Street 2:203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-1127
Mailing Address - Country:US
Mailing Address - Phone:904-354-8200
Mailing Address - Fax:904-354-1340
Practice Address - Street 1:425 N LEE ST
Practice Address - Street 2:203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1127
Practice Address - Country:US
Practice Address - Phone:904-354-8200
Practice Address - Fax:904-354-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39556OtherBCBS OF FLORIDA
FL0900158001OtherCIGNA
FL2059879OtherAETNA
FL371841700Medicaid
FL2059879OtherAETNA
FL39556Medicare PIN