Provider Demographics
NPI:1558509596
Name:NEUROLOGY ASSOCIATES OF NORTH FLORIDA DIAGNOSTICS,INC.
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF NORTH FLORIDA DIAGNOSTICS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOEHME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-249-4456
Mailing Address - Street 1:PO BOX 17809
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-7809
Mailing Address - Country:US
Mailing Address - Phone:904-249-4456
Mailing Address - Fax:904-249-7703
Practice Address - Street 1:1361 13TH AVE S
Practice Address - Street 2:STE 170A
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3233
Practice Address - Country:US
Practice Address - Phone:904-249-4456
Practice Address - Fax:904-249-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62533173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAXID