1821472341 NPI number — NEUROLOGY CLINIC OF JACKSONVILLE LLC

Table of content: (NPI 1821472341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821472341 NPI number — NEUROLOGY CLINIC OF JACKSONVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGY CLINIC OF JACKSONVILLE 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:
1821472341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9838 OLD BAYMEADOWS RD
Provider Second Line Business Mailing Address:
STE 377
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256-8101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
512-233-5299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9838 OLD BAYMEADOWS RD
Provider Second Line Business Practice Location Address:
STE 377
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256-8101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-570-4444
Provider Business Practice Location Address Fax Number:
512-233-5299
Provider Enumeration Date:
07/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PARIKH
Authorized Official First Name:
RAJUL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
512-296-4126

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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