Provider Demographics
NPI:1619184520
Name:JOHN ASSI, MD, PA
Entity Type:Organization
Organization Name:JOHN ASSI, MD, PA
Other - Org Name:CHILDREN'S HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-398-1471
Mailing Address - Street 1:3710 GRANDY AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-6112
Mailing Address - Country:US
Mailing Address - Phone:904-398-1471
Mailing Address - Fax:
Practice Address - Street 1:1522 EMERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-6102
Practice Address - Country:US
Practice Address - Phone:904-396-3964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271710700Medicaid
FL263972604Medicaid
FL263972605Medicaid
FL273550400Medicaid
FL271799900Medicaid
FL261957100Medicaid
FL263972606Medicaid
FL049478000Medicaid
FL263972600Medicaid
FL263972601Medicaid
FL263972602Medicaid
FL264779600Medicaid
FL270050600Medicaid
FL277454200Medicaid
FL000802100Medicaid
FL263972603Medicaid
FL270738100Medicaid
FL274771500Medicaid