Provider Demographics
NPI:1174541841
Name:JACKSONVILLE OPERATING COMPANY LLC
Entity type:Organization
Organization Name:JACKSONVILLE OPERATING COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-517-5500
Mailing Address - Street 1:7900 BELFORT PARKWAY
Mailing Address - Street 2:301
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6978
Mailing Address - Country:US
Mailing Address - Phone:904-517-5500
Mailing Address - Fax:904-517-5501
Practice Address - Street 1:7900 BELFORT PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6978
Practice Address - Country:US
Practice Address - Phone:904-281-0107
Practice Address - Fax:904-281-0788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN SLEEP MEDICINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4270Medicare ID - Type Unspecified