1104085752 NPI number — UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104085752 NPI number — UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.
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:
UFJP NEUROLOGY
Provider Other Organization Name Type Code:
5
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:
1104085752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 44008
Provider Second Line Business Mailing Address:
UFJP PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32231-4008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-244-3660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 W 8TH ST
Provider Second Line Business Practice Location Address:
UFJP NEUROLOGY
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32209-6533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-383-1022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BENRUBI
Authorized Official First Name:
GUY
Authorized Official Middle Name:
I.
Authorized Official Title or Position:
CEO/VICE PRESIDENT
Authorized Official Telephone Number:
904-244-3109

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081N0008X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081P0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 376698519 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".