Provider Demographics
NPI:1801021787
Name:MEDICAL ASSOCIATES OF NORTH FLORIDA, INC.
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF NORTH FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KLEINER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-328-2238
Mailing Address - Street 1:3948 3RD ST S
Mailing Address - Street 2:SUITE 1320
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5847
Mailing Address - Country:US
Mailing Address - Phone:904-328-2238
Mailing Address - Fax:904-212-1719
Practice Address - Street 1:3948 3RD ST S
Practice Address - Street 2:SUITE 1320
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5847
Practice Address - Country:US
Practice Address - Phone:904-328-2238
Practice Address - Fax:904-212-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEMT 300287146N00000X
FLRN 9182095163W00000X
FLME 80275208VP0014X
FLAL 377246Z00000X
FL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty