Provider Demographics
NPI:1962496273
Name:S. ALI SAFI, M.D. PEDIATRICS
Entity Type:Organization
Organization Name:S. ALI SAFI, M.D. PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEIED
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:SAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD/ PERDIATRICAN
Authorized Official - Phone:904-564-2700
Mailing Address - Street 1:8017 WOODGROVE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7242
Mailing Address - Country:US
Mailing Address - Phone:904-564-2700
Mailing Address - Fax:904-564-2800
Practice Address - Street 1:9770 OLD BAYMEADOWS RD
Practice Address - Street 2:#109
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7909
Practice Address - Country:US
Practice Address - Phone:904-564-2700
Practice Address - Fax:904-564-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5805026OtherAETNA
FL08314OtherBLUE CROSS BLUE SHIELD
FL061396700Medicaid
FL=========OtherUNITED HEALTHCARE
FL08314OtherBLUE CROSS BLUE SHIELD
FL=========OtherUNITED HEALTHCARE