JACKSONVILLE CHILDREN'S AND MULTISPECIALTY CLINIC, PA (NPI# 1164519070) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164519070 |
| Entity Type | Organization |
| Organization Name | JACKSONVILLE CHILDREN'S AND MULTISPECIALTY CLINIC, PA |
| Practice Address |
118 Memorial Dr Jacksonville NC 28546-6328 |
| Practice Telephone | 9103530581 |
| Practice Fax Number | 9105771150 |
| Mailing Telephone | 9103530581 |
| Mailing Fax Number | 9109394269 |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-10-21 |
| Authorized Official Name | DR. MADHUR MITTAL (PRESIDENT) |
| Authorized Official Telephone | 9103530581 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207KA0200X |
Allergy & Immunology Specialization: Allergy |
Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1164519070 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 114 Memorial Dr Ste C, Jacksonville, NC 285466328 | 9103539688 | 9103537498 |
| 108 Lakeside Dr, Sneads Ferry, NC 284609415 | 9103275437 | 9103275436 |
| 5710 Oleander Dr Ste 200, Wilmington, NC 284034722 | 9107991810 | 9107999644 |
| 1106 Main Street Ext, Swansboro, NC 285849114 | 9103250581 | 9103250582 |
| 107 S Wilmington St, Richlands, NC 285748298 | 9103247268 | 9103247273 |
| 319 Wb Mclean Dr, Cape Carteret, NC 285848516 | 2524240004 | 2527640019 |
| 114 Memorial Dr Ste A, Jacksonville, NC 285466328 | 9103530700 | 9103535305 |
| 152 Memorial Ct, Jacksonville, NC 285466322 | 9102198326 | |
| 3221 Henderson Dr, Jacksonville, NC 285465251 | 9102198326 | 9109394269 |
| 3004 Bridges St, Morehead City, NC 285573330 | 2524992211 | 2527274936 |
| 120 Memorial Dr, Jacksonville, NC 285466328 | 9103530581 | 9103531351 |
| 118 Memorial Dr, Jacksonville, NC 285466328 | 9103530581 | 9105771150 |
| 3004 Bridges St, Morehead City, NC 285573330 | 9102198326 | 9109394269 |
| 114a Memorial Dr, Jacksonville, NC 285466328 | 9103530700 | |
| 114c Memorial Dr, Jacksonville, NC 285466328 | 9103530600 |
| Street Address |
118 MEMORIAL DR |
| City | JACKSONVILLE |
| State | NC |
| Zip Code | 28546-6328 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073513875 | Anna Skaskiw | Pediatrics | 118 Memorial Dr, Jacksonville, NC 28546-6328 | 2005-07-22 |
| 1174151658 | Samantha Ruth Ferguson | Nurse Practitioner | 118 Memorial Dr, Jacksonville, NC 28546-6328 | 2020-03-30 |
| 1245862424 | Jordan Kate Mccormick | Nurse Practitioner | 118 Memorial Dr, Jacksonville, NC 28546-6328 | 2020-02-06 |
| 1609435684 | Katie Lynn Hill | Nurse Practitioner | 118 Memorial Dr, Jacksonville, NC 28546-6328 | 2019-06-12 |
| 1699274050 | Marsha Currin Hull | Nurse Practitioner | 118 Memorial Dr, Jacksonville, NC 28546-6328 | 2018-02-12 |
| 1992125322 | Duy An Tran Minior | Pediatrics | 118 Memorial Dr, Jacksonville, NC 28546-6328 | 2014-04-24 |
| 1447587423 | Lindsey Boxxe Fiacco | Pediatrics | 118 Memorial Dr, Jacksonville, NC 28546-6328 | 2009-11-11 |
| 1669592457 | Kimberly A Lewis | Physician Assistant | 118 Memorial Dr, Jacksonville, NC 28546-6328 | 2007-03-29 |
| 1447361480 | Arnold Camacho Olegario | Pediatrics | 118 Memorial Dr, Jacksonville, NC 28546-6328 | 2006-08-31 |
| 1548201890 | Mary L Wisniewski | Pediatrics | 118 Memorial Dr, Jacksonville, NC 28546-6328 | 2006-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316578388 | Judylyn Hobson | Registered Nurse | Pride In North Carolina, LLC, 3886 Henderson Dr, Jacksonville, NC 28546 | 2020-01-29 |
| 1427694637 | Aaron Patrick Bettcher | Military Health Care Provider | 3rd Mrb Loop Rd, Camp Lejeune, NC 28546 | 2019-11-22 |
| 1962044289 | Levi Scott Marshall | Military Health Care Provider | Everett Creek Road, Building 612, Camp Lejeune, NC 28546 | 2019-10-09 |
| 1649826652 | Nicholas Otazo | Military Health Care Provider | 3rd Mrb 20073, Camp Lejeune, NC 28546 | 2019-08-15 |
| 1417519570 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 2001 Marlin Drive Unit 100, Jacksonville, NC 28546 | 2019-06-28 |
| 1023500212 | Josip Ninrodriguez | Military Health Care Provider | 3d Marine Raider Battaliom, Camp Lejeune, NC 28546 | 2018-06-04 |
| 1639661192 | Kenneth Lee Russell | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28546 | 2018-05-31 |
| 1346730173 | Coastal Foot Center, LLC | Clinic/Center | 29 Office Park Dr Ste B, Jacksonville, NC 28546 | 2018-05-17 |
| 1578080271 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 380 Western Blvd, Jacksonville, NC 28546 | 2017-08-24 |
| 1144757493 | Darin Lee Peterson | Specialist/Technologist | G644 Camp Geiger, School of Infantry-east, Jacksonville, NC 28546 | 2017-05-17 |
| Find all providers in zip 28546 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528676186 | Sarah Colleen Tapscott | Family Medicine | 1908 Mill Creek Rd, Jacksonville, FL 32211-5052 | 2020-07-20 |
| 1790303170 | Samantha L Scott | Family Medicine | 516 Pierce Ln, Jacksonville, TX 75766-4546 | 2020-07-11 |
| 1689298689 | Meridian Spine and Joint, Inc | Family Medicine | 9770 Old Baymeadows Rd Ste 139, Jacksonville, FL 32256-7986 | 2020-06-04 |
| 1154942563 | Families First Medical Group | Family Medicine | 12086 Fort Caroline Rd Ste 103, Jacksonville, FL 32225-2688 | 2020-04-27 |
| 1598396392 | Pareto Population Health Management Practice Pllc | Family Medicine | 1697 Kings Rd Ste 1, Jacksonville, FL 32209-6169 | 2020-01-30 |
| 1942862206 | Cindy S Wright Do Pllc | Family Medicine | 12627 San Jose Blvd Ste 902, Jacksonville, FL 32223-8645 | 2019-07-07 |
| 1942868377 | Pain Spine & Wellness LLC | Family Medicine | 9770 Old Baymeadows Rd Ste 141, Jacksonville, FL 32256-7986 | 2019-05-31 |
| 1669035705 | Kathy Jo Daniels | Family Medicine | 10457 Wellington Springs Way, Jacksonville, FL 32221-1175 | 2019-04-15 |
| 1821579103 | Tiffany N Major | Family Medicine | 5194 Johnson Creek Dr, Jacksonville, FL 32218-9308 | 2018-08-24 |
| 1568987360 | Main Street Health LLC | Family Medicine | 2 Shircliff Way Ste 620, Jacksonville, FL 32204-4762 | 2017-08-14 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 28546 |
Please comment or provide details below to improve the information on JACKSONVILLE CHILDREN'S AND MULTISPECIALTY CLINIC, PA.
| 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.