Provider Demographics
NPI:1053366880
Name:THE DOCTORS CENTER INC
Entity type:Organization
Organization Name:THE DOCTORS CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-459-3661
Mailing Address - Street 1:9857 OLD SAINT AUGUSTINE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8821
Mailing Address - Country:US
Mailing Address - Phone:904-861-1900
Mailing Address - Fax:904-292-9684
Practice Address - Street 1:9857 OLD SAINT AUGUSTINE RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8821
Practice Address - Country:US
Practice Address - Phone:904-861-1900
Practice Address - Fax:904-292-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1018488OtherOTHER ID NUMBER-COMMERCIAL NUMBER
FL39739OtherBLUE CROSS BLUE SHIELD
FL003078200Medicaid
1018488OtherOTHER ID NUMBER