Provider Demographics
NPI:1528010923
Name:CENTER FOR MEDICINE AND PSYCHIATRY
Entity Type:Organization
Organization Name:CENTER FOR MEDICINE AND PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:O
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-398-0009
Mailing Address - Street 1:PO BOX 10339
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32247-0339
Mailing Address - Country:US
Mailing Address - Phone:904-398-0009
Mailing Address - Fax:904-346-0887
Practice Address - Street 1:1408 SAN MARCO BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8536
Practice Address - Country:US
Practice Address - Phone:904-398-0009
Practice Address - Fax:904-346-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00438272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1170Medicare ID - Type UnspecifiedMEDICARE GROUP