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Organization
NORTH FLORIDA MEDICAL CLINIC INC
Active
Organization
NORTH FLORIDA MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLTHAUS KEVIN MD (PRESIDENT)
(904) 242-7177
Entity
Organization
Contact information
Practice address
1361 13TH AVE S STE 150, JACKSONVILLE BEACH, FL 32250-3235
(904) 242-7177
(904) 242-7162
Mailing address
PO BOX 17809, JACKSONVILLE, FL 32245-7809
(904) 723-0015
(904) 338-0951
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME43785
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639126907
NPI
—
01
—
94954
BCBS
FL
01
—
DD6503
RAILROAD MEDICARE
FL
Enumeration date
05/30/2006
Last updated
01/24/2012
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