Provider Demographics
NPI:1407016645
Name:UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS INC
Entity Type:Organization
Organization Name:UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS INC
Other - Org Name:UF HEALTH MOLECULAR PATHOLOGY LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:I
Authorized Official - Last Name:BENRUBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-244-3109
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:
Practice Address - Street 1:655 W 11TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-3516
Practice Address - Country:US
Practice Address - Phone:904-633-0989
Practice Address - Fax:904-244-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========080OtherTRICARE
FL=========080OtherTRICARE