Provider Demographics
NPI:1710958756
Name:THE CHESAPEAKE CENTER
Entity Type:Organization
Organization Name:THE CHESAPEAKE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ANESTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:904-542-7632
Mailing Address - Street 1:2327 YELLOW JASMINE LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-3370
Mailing Address - Country:US
Mailing Address - Phone:904-269-6226
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7632
Practice Address - Fax:904-542-7623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9230669286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital