# FIRST COAST MEDICAL ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760881163
- **Authorized official:** RAVI K KANCHA MD (DOCTO)
- **Authorized official phone:** (904) 400-6800

## Contact information

- **Practice address:** 13241 BARTRAM PARK BLVD UNIT 413, JACKSONVILLE, FL 32258-5237
- **Practice address phone:** (904) 400-6800
- **Practice address fax:** (904) 400-6801
- **Mailing address:** 13241 BARTRAM PARK BLVD UNIT 413, JACKSONVILLE, FL 32258-5237
- **Mailing address phone:** (904) 400-6800
- **Mailing address fax:** (904) 400-6801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 305R00000X | Preferred Provider Organization | ME98044 | FL | — |

## Other

- **Enumeration date:** 08/21/2014
- **Last updated:** 11/12/2014