Provider Demographics
NPI:1518145887
Name:JASON MANUEL PA
Entity Type:Organization
Organization Name:JASON MANUEL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-223-8818
Mailing Address - Street 1:13400 SUTTON PARK DR S STE 1103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0235
Mailing Address - Country:US
Mailing Address - Phone:904-223-8818
Mailing Address - Fax:904-223-6969
Practice Address - Street 1:13400 SUTTON PARK DR S STE 1103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0235
Practice Address - Country:US
Practice Address - Phone:904-223-8818
Practice Address - Fax:904-223-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6580198195332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4257970001Medicare NSC
FLCZ223AMedicare PIN