Organization
JACKSONVILLE LUNG CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD PEW (VICE PRESIDENT)
(307) 262-9410
Entity
Organization
Contact information
Practice address
1350 13TH AVE S, JACKSONVILLE BEACH, FL 32250-3203
(904) 627-2900
(904) 253-3098
Mailing address
7500 RIALTO BLVD, AUSTIN, TX 78735-8531
(512) 730-3060
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022274400
—
FL
Enumeration date
02/05/2018
Last updated
01/07/2025
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