Provider Demographics
NPI:1427481647
Name:FAMILY MEDICINE & REHAB
Entity type:Organization
Organization Name:FAMILY MEDICINE & REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:SAJID
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-388-7964
Mailing Address - Street 1:7685 103RD ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-9325
Mailing Address - Country:US
Mailing Address - Phone:904-388-7964
Mailing Address - Fax:904-388-7002
Practice Address - Street 1:7685 103RD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-9325
Practice Address - Country:US
Practice Address - Phone:904-388-7964
Practice Address - Fax:904-388-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD088Medicare PIN