Provider Demographics
NPI:1245489038
Name:NORTH FLORIDA ACUTE CARE SPECIALISTS LLC
Entity type:Organization
Organization Name:NORTH FLORIDA ACUTE CARE SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DASTAGIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-955-7190
Mailing Address - Street 1:PO BOX 551698
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1698
Mailing Address - Country:US
Mailing Address - Phone:904-276-6903
Mailing Address - Fax:800-431-0524
Practice Address - Street 1:5991 CHESTER AVE STE 211
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2245
Practice Address - Country:US
Practice Address - Phone:904-517-1400
Practice Address - Fax:800-431-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000767800Medicaid
FL99966OtherBCBS
FL000767800Medicaid