Provider Demographics
NPI:1316907926
Name:NORTH FLORIDA OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES PA
Entity type:Organization
Organization Name:NORTH FLORIDA OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:904-472-2300
Mailing Address - Street 1:PO BOX 16568
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6568
Mailing Address - Country:US
Mailing Address - Phone:904-472-2300
Mailing Address - Fax:904-472-2330
Practice Address - Street 1:11437 CENTRAL PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2706
Practice Address - Country:US
Practice Address - Phone:904-472-2300
Practice Address - Fax:904-472-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370581101Medicaid
FL370581118Medicaid
FL370581119Medicaid
FL370581129Medicaid
FL370581108Medicaid
FL370581112Medicaid
FL370581102Medicaid
FL370581116Medicaid
FL370581100Medicaid
FL370581104Medicaid
FL370581110Medicaid
FL370581123Medicaid
FL370581103Medicaid
FL370581106Medicaid
FL370581126Medicaid
FL370581105Medicaid
FL370581117Medicaid
FL370581120Medicaid
FL370581121Medicaid
FL370581109Medicaid
FL370581113Medicaid
FL370581114Medicaid
FL370581125Medicaid
FL370581107Medicaid
FL370581115Medicaid
FL370581128Medicaid
FL00933Medicare PIN