Provider Demographics
NPI:1184614166
Name:INTERNAL MEDICINE ASSOCIATES OF JACKSONVILLE P A
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF JACKSONVILLE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:LEV
Authorized Official - Last Name:MADFIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-737-6200
Mailing Address - Street 1:6320 SAINT AUGUSTINE RD
Mailing Address - Street 2:UNIT 12
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2800
Mailing Address - Country:US
Mailing Address - Phone:904-737-6200
Mailing Address - Fax:904-737-6001
Practice Address - Street 1:6320 SAINT AUGUSTINE RD
Practice Address - Street 2:UNIT 12
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2800
Practice Address - Country:US
Practice Address - Phone:904-737-6200
Practice Address - Fax:904-737-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty