COASTAL INJURY CLINIC LLC (NPI# 1437768033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1437768033 |
Entity Type | Organization |
Organization Name | COASTAL INJURY CLINIC LLC |
Practice Address |
2700 Riverside Ave Ste 1 Jacksonville FL 32205-8233 |
Mailing Address |
Po Box 1869 Orange Park FL 32067-1869 |
Practice Telephone | 9045596638 |
Practice Fax Number | 8889270401 |
Mailing Telephone | 9045596638 |
Mailing Fax Number | 8889270401 |
Enumeration Date | 2020-07-29 |
Last Update Date | 2020-07-29 |
Authorized Official Name | MRS. ZANDA M CHANDLER (VICE PRESIDENT OF FINANCE) |
Authorized Official Telephone | 9042826331 |
Is Organization Subpart | Y |
Parent Organization Name | PHYSICIANS GROUP SERVICES PA |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 174400000X | Specialist | Other Service Providers | ||
N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
Address | Telephone Number | Fax Number |
---|---|---|
14011 Beach Blvd Ste 220, Jacksonville, FL 322501695 | 9045596638 | 8889270401 |
421 Kingsley Ave Ste 400, Orange Park, FL 320734898 | 9045596638 | 8889270401 |
Street Address |
2700 RIVERSIDE AVE STE 1 |
City | JACKSONVILLE |
State | FL |
Zip Code | 32205-8233 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1003466830 | Brandon Neil Hillard | Registered Nurse | 1260 Mcduff Ave. South, Suite 4, Jacksonville, FL 32205 | 2019-09-13 |
1720436363 | Ericka Sampson | Massage Therapist | 6859 Lenox Ave., Suite 6, Jacksonville, FL 32205 | 2016-05-24 |
1578921631 | Northstar Counseling | Counselor | 1672 Pershing Rd, Jacksonville, FL 32205 | 2016-02-04 |
1649645144 | Magaly Perez-cruz | Speech-Language Pathologist | 4101-1 College Street, Jacksonville, FL 32205 | 2015-12-09 |
1639448723 | First Choice Adult Daycare and Home Health Ca | Specialist | 5336 Quan Drive, Jacksonville, FL 32205 | 2011-12-20 |
1437434222 | Christopher Styer | Pharmacist | 654 Casset Ave, Jacksonville, FL 32205 | 2011-10-12 |
1871827279 | April Marie Felton | Nurse Practitioner | 500 E. Adams Street, Bay Street Health Center, Jacksonville, FL 32205 | 2009-10-01 |
1922244821 | Danielle Marie Sergent | Physical Therapist | 5222 Lenox Ave., Jacksonville, FL 32205 | 2008-12-23 |
1427181775 | Lapp & Associates Behavioral Counselind Ctr | Counselor | 931 Cassat Avenue, Jacksonville, FL 32205 | 2007-03-14 |
1629143326 | Elias Moussa Sargi | Dentist | 2700 Riverside Avenue, Ste 10, Jacksonville, FL 32205 | 2006-11-21 |
Find all providers in zip 32205 |
Taxonomy Code | 2081P2900X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Physical Medicine & Rehabilitation |
Specialization | Pain Medicine |
A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962565457 | Mark Charles Hofmann | Physical Medicine & Rehabilitation | 2968 Rainbow Rd, Jacksonville, FL 32217-2435 | 2006-12-18 |
1578669933 | Jawed Hussain | Physical Medicine & Rehabilitation | 4063 Salisbury Rd Ste 100, Jacksonville, FL 32216-6199 | 2006-09-15 |
1396792818 | Allevia Medical, LLC | Physical Medicine & Rehabilitation | 14482 Cherry Lake Dr E, Jacksonville, FL 32258-5178 | 2006-05-29 |
1427011741 | Frank R Collier Jr. | Physical Medicine & Rehabilitation | 2627 Riverside Ave Fl 3, Jacksonville, FL 32204-4712 | 2006-04-08 |
1467445403 | Bao Tien Pham | Physical Medicine & Rehabilitation | 6816 Southpoint Pkwy, Suite 302, Jacksonville, FL 32216-1700 | 2005-08-24 |
1790045623 | Kyle R Bovee | Physical Medicine & Rehabilitation | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2012-05-25 |
1932428380 | Monika Yogesh Patel | Physical Medicine & Rehabilitation | 655 W 8th St, Jacksonville, FL 32209-6511 | 2010-05-25 |
1124273529 | Sunshine Spine and Pain, Pa | Physical Medicine & Rehabilitation | 3 Shircliff Way, Suite 610, Jacksonville, FL 32204-4757 | 2008-11-26 |
1215118062 | Accmed Healthcare Systems Inc | Physical Medicine & Rehabilitation | 6816 Southpoint Pkwy, Suite 302, Jacksonville, FL 32216-1700 | 2007-11-21 |
1801000161 | Ferdinand Joseph Formoso | Physical Medicine & Rehabilitation | 11555 Central Pkwy, Suite 304, Jacksonville, FL 32224-2691 | 2007-05-09 |
Find all providers in JACKSONVILLE |
City | JACKSONVILLE |
Zip Code | 32205 |
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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.