Provider Demographics
NPI:1407946387
Name:PULMONARY & CRITICAL CARE CONSULTANTS OF JACKSONVILLE PL
Entity Type:Organization
Organization Name:PULMONARY & CRITICAL CARE CONSULTANTS OF JACKSONVILLE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAKRAVARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-739-6666
Mailing Address - Street 1:PO BOX 551537
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1537
Mailing Address - Country:US
Mailing Address - Phone:904-739-6666
Mailing Address - Fax:904-739-1009
Practice Address - Street 1:8075 GATE PKWY W
Practice Address - Street 2:SUITE 304
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3684
Practice Address - Country:US
Practice Address - Phone:904-739-6666
Practice Address - Fax:904-739-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53176207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF4633OtherRAILROAD MEDICARE GROUP
FLG40048Medicare UPIN
DF4633Medicare PIN
FLQ0399Medicare PIN
FLDF4633OtherRAILROAD MEDICARE GROUP