Provider Demographics
NPI:1467616169
Name:PHYSICIANS GROUP SERVICES PA
Entity Type:Organization
Organization Name:PHYSICIANS GROUP SERVICES PA
Other - Org Name:FAMILY MEDICAL CENTER SAN PABLO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHRISTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-685-7688
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-619-1080
Practice Address - Street 1:14011 BEACH BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1507
Practice Address - Country:US
Practice Address - Phone:904-223-6400
Practice Address - Fax:904-223-6420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS GROUP SERVICES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-11
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259123502Medicaid
FL259123502Medicaid