Provider Demographics
NPI:1780979880
Name:ARLENE G. SCHLUMBOHM, DO, PA
Entity type:Organization
Organization Name:ARLENE G. SCHLUMBOHM, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHLUMBOHM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-482-1083
Mailing Address - Street 1:4205 BELFORT RD
Mailing Address - Street 2:STE. 3004
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1471
Mailing Address - Country:US
Mailing Address - Phone:904-482-1083
Mailing Address - Fax:904-482-1089
Practice Address - Street 1:4205 BELFORT RD
Practice Address - Street 2:STE. 3004
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1471
Practice Address - Country:US
Practice Address - Phone:904-482-1083
Practice Address - Fax:904-482-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF91770Medicare UPIN