Provider Demographics
NPI:1609359249
Name:CAREMAX CLINIC 711 LLC
Entity Type:Organization
Organization Name:CAREMAX CLINIC 711 LLC
Other - Org Name:VALUECARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAMTORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-289-1254
Mailing Address - Street 1:PO BOX 600365
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32260-0365
Mailing Address - Country:US
Mailing Address - Phone:904-289-1254
Mailing Address - Fax:904-202-0036
Practice Address - Street 1:2732 TROLLIE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3833
Practice Address - Country:US
Practice Address - Phone:904-289-1254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty