Provider Demographics
NPI:1851713887
Name:JANET A BETCHKAL MD PA
Entity Type:Organization
Organization Name:JANET A BETCHKAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BETCHKAL, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:904-384-3500
Mailing Address - Street 1:3 SHIRCLIFF WAY STE 134
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4785
Mailing Address - Country:US
Mailing Address - Phone:904-384-3500
Mailing Address - Fax:904-388-9132
Practice Address - Street 1:3 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 134
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4757
Practice Address - Country:US
Practice Address - Phone:904-384-3500
Practice Address - Fax:904-388-9132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024956300Medicaid
FL07521ZMedicare PIN
FL049070900Medicaid