Organization
FIRST COAST LTC, INC
Active
Parent organization
FIRST COAST LTC, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FIRST COAST LTC, INC
Authorized official
DR. DAVID SAMARA MD (PRESIDENT)
(904) 309-6504
Entity
Organization
Contact information
Practice address
25 STATE ROAD 13, ATT: CLINIC, SAINT JOHNS, FL 32259-2842
(904) 309-6504
(904) 503-3577
Mailing address
6555 CHESTER AVE STE 1, JACKSONVILLE, FL 32217-2279
(904) 309-6504
(904) 503-3577
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME31637
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371340700
—
FL
01
—
CG-1814
RR MEDICARE
—
Enumeration date
08/31/2012
Last updated
03/07/2016
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