PHYSICIANS CHOICE DIALYSIS OF JACKSONVILLE, LLC (NPI# 1386829489) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386829489 |
| Entity Type | Organization |
| Organization Name | PHYSICIANS CHOICE DIALYSIS OF JACKSONVILLE, LLC |
| Practice Address |
331 Henry Road Sw Jacksonville AL 36265 |
| Mailing Address |
211 Commerce Ct Suite 104 Pottstown PA 19464-3483 |
| Practice Telephone | 6104958900 |
| Practice Fax Number | 6104958560 |
| Mailing Telephone | 6104958900 |
| Mailing Fax Number | 6104958560 |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2009-10-02 |
| Authorized Official Name | MRS. RHONDA B PALUMBO (DIRECTOR OF CONTRACTS/HR) |
| Authorized Official Telephone | 6104958900 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | DIA2625D | 05 |
| Street Address |
331 HENRY ROAD SW |
| City | JACKSONVILLE |
| State | AL |
| Zip Code | 36265 |
| 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 |
| 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 |
| 1568571602 | Family Practice of Jacksonville PC | Family Medicine | 1881 Hwy 21 South, Jacksonville, AL 36265 | 2006-08-30 |
| Find all providers in zip 36265 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487274734 | Bio-medical Applications of Florida, Inc. | Clinic/Center | 2777 University Blvd W Ste 39, Jacksonville, FL 32217-2143 | 2020-04-16 |
| 1063980969 | Total Renal Care, Inc | Clinic/Center | 8021 Philips Hwy Ste 15, Jacksonville, FL 32256-4452 | 2018-11-08 |
| 1720538556 | Total Renal Care Inc | Clinic/Center | 5276 Blanding Blvd Ste 26, Jacksonville, FL 32210 | 2016-10-05 |
| 1588017784 | Lake Gray Dialysis Center LLC | Clinic/Center | 6196 Lake Gray Blvd, Suite 112, Jacksonville, FL 32244-7503 | 2016-07-22 |
| 1891143103 | Bio-medical Applications of Florida, Inc. | Clinic/Center | 1211 St. Johns Bluff Rd North, Jacksonville, FL 32225 | 2016-05-26 |
| 1457725806 | Bio-medical Applications of Florida, Inc. | Clinic/Center | 3107 Edgewood Ave West, Jacksonville, FL 32209-2209 | 2015-11-23 |
| 1912307596 | Total Renal Care of North Carolina LLC | Clinic/Center | 111 Yopp Road, Jacksonville, NC 28540-3509 | 2014-09-02 |
| 1497186084 | Bio-medical Applications of Florida, Inc. | Clinic/Center | 5607 Normandy Blvd, Jacksonville, FL 32205-6248 | 2013-12-06 |
| 1144653270 | Nxstage Jacksonville, LLC | Clinic/Center | 2777 University Blvd W, Suite 39, Jacksonville, FL 32217-2176 | 2013-08-13 |
| 1114284494 | Kidney Kare of Jacksonville Fl, Inc. | Clinic/Center | 4168 Southpoint Pkwy, Jacksonville, FL 32216-0966 | 2012-04-11 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 36265 |
Please comment or provide details below to improve the information on PHYSICIANS CHOICE DIALYSIS OF JACKSONVILLE, 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.