Provider Demographics
NPI:1699872812
Name:ATLANTIC FAMILY MEDICAL CENTER OF JACKSONVILLE PL
Entity type:Organization
Organization Name:ATLANTIC FAMILY MEDICAL CENTER OF JACKSONVILLE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-221-2222
Mailing Address - Street 1:13155 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3125
Mailing Address - Country:US
Mailing Address - Phone:904-221-2222
Mailing Address - Fax:904-221-2024
Practice Address - Street 1:13155 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3125
Practice Address - Country:US
Practice Address - Phone:904-221-2222
Practice Address - Fax:904-221-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45512OtherBLUE CROSS GROUP NUMBER
FL45512OtherBLUE CROSS GROUP NUMBER
FLK0967Medicare ID - Type UnspecifiedGROUP NUMBER