W.B. STEWART TIGERS ATHLETICS BOOSTERS (NPI# 1841794682) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841794682 |
| Entity Type | Organization |
| Organization Name | W.B. STEWART TIGERS ATHLETICS BOOSTERS |
| Other Organization Name | EWC SPORTS MEDICINE |
| Practice Address |
1658 Kings Rd Jacksonville FL 32209-6167 |
| Mailing Address |
5050 Spring Valley Rd Dallas TX 75244-3995 |
| Practice Telephone | 9723674845 |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2018-03-19 |
| Authorized Official Name | MOUZON BASS (AGENT) |
| Authorized Official Telephone | 9723674845 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| EWC Sports Medicine | Doing Business As Name - Organization |
| Street Address |
1658 KINGS RD |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32209-6167 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710506183 | Hayley M Shade | Student in an Organized Health Care Education/Training Program | 655 8th St. W., 4th Floor, Lrc 653-1 West 8th Street, L18, Jacksonville, FL 32209 | 2020-04-15 |
| 1407484629 | Micah Christine Turpeau | Student in an Organized Health Care Education/Training Program | 580 W. 8th St., Tower II, Suite 6005, Jacksonville, FL 32209 | 2020-04-01 |
| 1730716366 | Nikki Javia | Student in an Organized Health Care Education/Training Program | 653-1 W 8th St, Fl 4, Lrc Box L16, Jacksonville, FL 32209 | 2020-03-24 |
| 1336776061 | Samuel Kamoroff | Student in an Organized Health Care Education/Training Program | 653-1 West 8th Street, 4th Floor, Lrc Box L16, Jacksonville, FL 32209 | 2020-03-24 |
| 1376194092 | Donald Wayne Johnson Jr. | Pharmacist | Uf Health Jacksonville, 655 West 8th Street, Jacksonville, FL 32209 | 2019-09-24 |
| 1871141838 | Anton Daran Armstrong | Counselor | 921 N. Davis St. Bldg. B, Suite 350, Jacksonville, FL 32209 | 2019-09-03 |
| 1295296499 | Christian King | Student in an Organized Health Care Education/Training Program | 580 W. 8th St., Tower II, Suite 6005, Jacksonville, FL 32209 | 2019-03-29 |
| 1013478403 | David William Barton | Orthopaedic Surgery | 655 W 8th St, Box C-126, Jacksonville, FL 32209 | 2019-03-27 |
| 1912497108 | Lisa Jordan | Adult Companion | 1515 W 31st St, Jacksonville, FL 32209 | 2018-05-14 |
| 1275020968 | Eloisa Anne Ello-esma | Nurse Practitioner | W. 8th Street, Jacksonville, FL 32209 | 2018-04-18 |
| Find all providers in zip 32209 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033768981 | North Florida Pediatrics, Pa | Pediatrics | 4501 Atlantic Boulevard, Jacksonville, FL 32207 | 2019-09-04 |
| 1487755567 | Charles Richardson Martin | Pediatrics | 2 Dewitt St, Jacksonville, NC 28540-5649 | 2006-09-25 |
| 1336252444 | Charles B. Mcintosh | Pediatrics | 3160 Edgewood Ave W, Jacksonville, FL 32209-2245 | 2006-08-16 |
| 1922091156 | Anne T Egan | Pediatrics | 2121 Park St, Jacksonville, FL 32204-3811 | 2005-08-23 |
| 1326046350 | Iris Eisenberg | Pediatrics | 11521 N Main St, Jacksonville, FL 32218-4002 | 2005-07-13 |
| 1568856698 | Afton Turner | Pediatrics | 4788 Hodges Blvd Ste B108, Jacksonville, FL 32224-7222 | 2015-03-26 |
| 1316385164 | Rainbow Pediatric Center | Pediatrics | 4788 Hodges Blvd, Suite B-108, Jacksonville, FL 32224-7222 | 2013-06-13 |
| 1043456148 | Rachna A Krish | Pediatrics | 13241 Bartram Park Blvd, Suite # 209, Jacksonville, FL 32258-5212 | 2008-12-20 |
| 1043346745 | Jacksonville Pediatrics | Pediatrics | 2606 Park St, Jacksonville, FL 32204-4520 | 2007-02-26 |
| 1609925387 | Erica Tarbox | Pediatrics | 3945 San Jose Park Dr, Jacksonville, FL 32217-4612 | 2007-01-10 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32209 |
Please comment or provide details below to improve the information on W.B. STEWART TIGERS ATHLETICS BOOSTERS.
| 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.