Provider Demographics
NPI:1023522315
Name:RELIANCE MEDICAL ASSOCIATES OF JAX LLC
Entity type:Organization
Organization Name:RELIANCE MEDICAL ASSOCIATES OF JAX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-506-3925
Mailing Address - Street 1:2220 COUNTY ROAD 210 W STE 108
Mailing Address - Street 2:PMB 257
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4060
Mailing Address - Country:US
Mailing Address - Phone:321-506-3925
Mailing Address - Fax:
Practice Address - Street 1:8833 PERIMETER PARK BLVD STE 503
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1110
Practice Address - Country:US
Practice Address - Phone:904-687-1055
Practice Address - Fax:904-687-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121788208D00000X, 261QP2300X, 207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108669600Medicaid