Provider Demographics
NPI:1568469062
Name:JIRAYOS CHINTANADILOK
Entity Type:Organization
Organization Name:JIRAYOS CHINTANADILOK
Other - Org Name:EVEREST MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D. (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:JIRAYOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINTANADILOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-482-2061
Mailing Address - Street 1:4296 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2173
Mailing Address - Country:US
Mailing Address - Phone:850-482-2061
Mailing Address - Fax:850-482-6617
Practice Address - Street 1:4296 5TH AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2173
Practice Address - Country:US
Practice Address - Phone:850-482-2061
Practice Address - Fax:850-482-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27861207Q00000X
FLME77246207R00000X, 207RG0300X, 207RP1001X
FLPA9101074363AM0700X
FLARNP363LG0600X
FLARNP1903302363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269074800Medicaid
FL269074800Medicaid