Provider Demographics
NPI:1740477843
Name:FIRST COAST INFECTIOUS DISEASE CONSULTANTS LLC
Entity type:Organization
Organization Name:FIRST COAST INFECTIOUS DISEASE CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STANCIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-398-5614
Mailing Address - Street 1:PO BOX 55009
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0009
Mailing Address - Country:US
Mailing Address - Phone:904-398-5614
Mailing Address - Fax:904-398-5617
Practice Address - Street 1:2122 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8937
Practice Address - Country:US
Practice Address - Phone:904-398-5614
Practice Address - Fax:904-398-5617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0200X, 207RP1001X, 207RI0200X
FLME89939207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115420100Medicaid
FL273691800Medicaid
03409YMedicare PIN