Provider Demographics
NPI:1477942050
Name:JAX PATIENT CARE
Entity Type:Organization
Organization Name:JAX PATIENT CARE
Other - Org Name:JAXCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-309-9902
Mailing Address - Street 1:1431 RIVERPLACE BLVD APT 1404
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9101
Mailing Address - Country:US
Mailing Address - Phone:404-664-7216
Mailing Address - Fax:904-701-6236
Practice Address - Street 1:100 WHARFSIDE WAY # A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8104
Practice Address - Country:US
Practice Address - Phone:904-309-9902
Practice Address - Fax:904-701-6236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2488613416L0300X, 343900000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherPRIVATE
GA=========OtherPRIVATE