1619341039 NPI number — JACKSONVILLE MEDICAL GROUP, LLC

Table of content: DR. SARAH JEWEL PAGE D.O. (NPI 1811332075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619341039 NPI number — JACKSONVILLE MEDICAL GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSONVILLE MEDICAL GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619341039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
396 N LOMBARDY LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32259-5266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1409 KINGSLEY AVE
Provider Second Line Business Practice Location Address:
SUITE 9G
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-637-0037
Provider Business Practice Location Address Fax Number:
904-639-6017
Provider Enumeration Date:
11/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SOLEYMANI
Authorized Official First Name:
SAMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
904-962-7396

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME88018 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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