Provider Demographics
NPI:1659422236
Name:UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC
Entity Type:Organization
Organization Name:UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-VP
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENRUBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-244-6667
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP DURABLE MEDICAL EQUIPMENT-PROVIDER ENROLLMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3660
Practice Address - Fax:904-244-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1101330005Medicare NSC