Provider Demographics
NPI:1215118062
Name:ACCMED HEALTHCARE SYSTEMS INC
Entity type:Organization
Organization Name:ACCMED HEALTHCARE SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BAO
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-527-3135
Mailing Address - Street 1:5377 COMMISSIONERS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0830
Mailing Address - Country:US
Mailing Address - Phone:904-527-3135
Mailing Address - Fax:904-683-7986
Practice Address - Street 1:6816 SOUTHPOINT PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1700
Practice Address - Country:US
Practice Address - Phone:904-527-3135
Practice Address - Fax:904-683-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1671Medicare PIN