Provider Demographics
NPI:1942625520
Name:FIRST COAST NEPHROLOGY INC
Entity Type:Organization
Organization Name:FIRST COAST NEPHROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:SALIBA
Authorized Official - Last Name:SALAMEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-744-4448
Mailing Address - Street 1:PO BOX 57189
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-7189
Mailing Address - Country:US
Mailing Address - Phone:904-737-2722
Mailing Address - Fax:904-737-2723
Practice Address - Street 1:4123 UNIVERSITY BLVD S STE E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4320
Practice Address - Country:US
Practice Address - Phone:904-744-7300
Practice Address - Fax:904-281-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81937207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty