Provider Demographics
NPI:1053981142
Name:AVECINA MEDICAL PA
Entity type:Organization
Organization Name:AVECINA MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORETTI KIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-723-4707
Mailing Address - Street 1:4815 SWEETGRASS PL STE 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4160 SOUTHSIDE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8500
Practice Address - Country:US
Practice Address - Phone:904-900-1717
Practice Address - Fax:904-367-2143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVECINA MEDICAL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-30
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care