Provider Demographics
NPI:1881838084
Name:U.S. PREVENTIVE MEDICINE, INC.
Entity Type:Organization
Organization Name:U.S. PREVENTIVE MEDICINE, INC.
Other - Org Name:THE PREVENTION PLAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-562-6308
Mailing Address - Street 1:12724 GRAN BAY PKWY W STE 150
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-9486
Mailing Address - Country:US
Mailing Address - Phone:904-562-6308
Mailing Address - Fax:
Practice Address - Street 1:12740 GRAN BAY PKWY W
Practice Address - Street 2:SUITE 2400
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5487
Practice Address - Country:US
Practice Address - Phone:904-281-0006
Practice Address - Fax:904-665-0097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. PREVENTIVE MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-01
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health