Organization
FIRST COAST LTC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J SAMARA MD (PRESIDENT)
(904) 309-6504
Entity
Organization
Contact information
Practice address
6555 CHESTER AVE STE 1, JACKSONVILLE, FL 32217-2279
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371340700
—
FL
01
—
CG-1814
RAILROAD MEDICARE
—
Enumeration date
06/28/2006
Last updated
03/07/2016
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