Provider Demographics
NPI:1922244417
Name:VIDYA S JAIN MD PA
Entity Type:Organization
Organization Name:VIDYA S JAIN MD PA
Other - Org Name:JAIN HAND SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:386-325-7711
Mailing Address - Street 1:800 ZEAGLER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3827
Mailing Address - Country:US
Mailing Address - Phone:386-325-7711
Mailing Address - Fax:386-325-3020
Practice Address - Street 1:800 ZEAGLER DR STE 100
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3827
Practice Address - Country:US
Practice Address - Phone:386-325-7711
Practice Address - Fax:386-325-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57658207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063376300Medicaid
FL063376300Medicaid