Provider Demographics
NPI:1952336083
Name:MEDIFIRST-MEDIFAST, INC
Entity Type:Organization
Organization Name:MEDIFIRST-MEDIFAST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-781-6203
Mailing Address - Street 1:1718 N EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254
Mailing Address - Country:US
Mailing Address - Phone:904-781-6203
Mailing Address - Fax:904-781-6207
Practice Address - Street 1:1718 N EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254
Practice Address - Country:US
Practice Address - Phone:904-781-6203
Practice Address - Fax:904-781-6207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039050000Medicaid
98918Medicare ID - Type Unspecified
15478WMedicare ID - Type Unspecified
085120Medicare UPIN