JACKSONVILLE SURGICAL & MEDICAL AFFILIATES, LLC (NPI# 1104078831) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104078831 |
| Entity Type | Organization |
| Organization Name | JACKSONVILLE SURGICAL & MEDICAL AFFILIATES, LLC |
| Practice Address |
1460 2nd Ave Sw Jacksonville AL 36265-3358 |
| Practice Telephone | 2567824395 |
| Mailing Telephone | 2567824395 |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2008-10-13 |
| Authorized Official Name | TAMMY COBB (CFO) |
| Authorized Official Telephone | 2567824520 |
| Authorized Official Credential | CPA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Street Address |
1460 2ND AVE SW |
| City | JACKSONVILLE |
| State | AL |
| Zip Code | 36265-3358 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639163397 | Russell Leon Ingram | Family Medicine | 1460 2nd Ave Sw, Jacksonville, AL 36265-3358 | 2005-09-08 |
| 1235316514 | Dr Muhamad Mazen Festok | Clinic/Center | 1460 2nd Ave Sw, B, Jacksonville, AL 36265-3358 | 2008-01-29 |
| 1699769174 | James Richard Yates | Internal Medicine | 1460 2nd Ave Sw, Jacksonville, AL 36265-3358 | 2005-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700436144 | Griffin Loflin | Specialist/Technologist | 775 Park Ave Nw, Attn. Sports Medicine, Jacksonville, AL 36265 | 2019-09-17 |
| 1114304011 | Caroline Ross | Counselor | 1215 Jackson Way Sw, Jacksonville, AL 36265 | 2015-04-29 |
| 1083001226 | Tracey Hudgins | Counselor | 1215 Jackson's Way, Jacksonville, AL 36265 | 2015-04-24 |
| 1235415118 | Adam Pike | Pharmacist | 311 Pelham Rd So, Jacksonville, AL 36265 | 2011-10-24 |
| 1386829489 | Physicians Choice Dialysis of Jacksonville, LLC | Clinic/Center | 331 Henry Road Sw, Jacksonville, AL 36265 | 2008-01-08 |
| 1659409365 | Kenneth Wayne Campbell | Nurse Anesthetist, Certified Registered | 1701 Pelham Road, Jacksonville Medical Center, Jacksonville, AL 36265 | 2007-03-02 |
| 1154478378 | Diana C. Ford | Counselor | 1250 Jackson's Way, Garrett Counseling Center, Jacksonville, AL 36265 | 2007-01-03 |
| 1487710950 | James Richard Morrison | Chiropractor | 1550 Pelham Rd. S., Jacksonville, AL 36265 | 2006-12-29 |
| 1447332937 | Millennium Anesthesia Services | Anesthesiology | 1701 Pelham Road S, Jacksonville, AL 36265 | 2006-10-20 |
| 1407943228 | Brunda Revanna, Md | Clinic/Center | 1465 A 1st Ave Sw Ste C, Jacksonville, AL 36265 | 2006-10-05 |
| Find all providers in zip 36265 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447898457 | Hyperbaric Therapy of Jacksonville | Clinic/Center | 11701 San Jose Blvd Ste 108, Jacksonville, FL 32223-0756 | 2019-12-20 |
| 1912548769 | Health Access Rx Services | Clinic/Center | 3050 Tamaya Blvd Apt 639, Jacksonville, FL 32246-1255 | 2019-10-03 |
| 1831568344 | Alignment Healthcare Florida LLC | Clinic/Center | 3501 Cortez Rd. West, Jacksonville, FL 34210 | 2015-09-15 |
| 1952770463 | Alignment Healthcare Florida LLC | Clinic/Center | 3520-1 St. Johns Bluff Rd., Jacksonville, FL 32246 | 2015-09-15 |
| 1336516814 | Alignment Healthcare Florida LLC | Clinic/Center | 5500 Blanding Blvd, Jacksonville, FL 32244-1946 | 2015-08-31 |
| 1629489141 | Amador Garcia Nazareno | Clinic/Center | 2258 Pocosin Ct, Jacksonville, FL 32246-4193 | 2014-05-19 |
| 1902188782 | Wellness Rehab Services Inc | Clinic/Center | 6550 San Augustin Rd, Ste 304, Jacksonville, FL 32217 | 2011-09-16 |
| 1346575800 | Learning Basics Inc | Clinic/Center | 12606 Arrowleaf Ln, Jacksonville, FL 32225-6848 | 2009-10-16 |
| 1114116811 | American Current Care Pa | Clinic/Center | 5600 Spring Park Road, Suite 100, Jacksonville, FL 32216 | 2007-10-18 |
| 1750574133 | Banister Chiropractic | Clinic/Center | 4111 Atlantic Boulevard, Jacksonville, FL 32207-2038 | 2007-08-20 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 36265 |
Please comment or provide details below to improve the information on JACKSONVILLE SURGICAL & MEDICAL AFFILIATES, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.