Provider Demographics
NPI:1679946735
Name:REID PHYSICIANS GROUP OF JACKSONVILLE LLC
Entity Type:Organization
Organization Name:REID PHYSICIANS GROUP OF JACKSONVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-646-4225
Mailing Address - Street 1:1205 MONUMENT RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6482
Mailing Address - Country:US
Mailing Address - Phone:904-646-4225
Mailing Address - Fax:904-646-4227
Practice Address - Street 1:1205 MONUMENT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6482
Practice Address - Country:US
Practice Address - Phone:904-646-4225
Practice Address - Fax:904-646-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85541207Q00000X
FLARNP9389534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268855700Medicaid
FL268855700Medicaid
FLIO361AMedicare PIN