Provider Demographics
NPI:1669053351
Name:ECHO MANAGED CARE, LLC
Entity type:Organization
Organization Name:ECHO MANAGED CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STRATEGY AND DEVELOPMENT OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SHADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-341-6322
Mailing Address - Street 1:100 ARRICOLA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-4515
Mailing Address - Country:US
Mailing Address - Phone:904-825-4368
Mailing Address - Fax:
Practice Address - Street 1:100 ARRICOLA AVE
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-4515
Practice Address - Country:US
Practice Address - Phone:904-825-4368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care