Organization Name: | JACKSONVILLE IMPOTENCE TREATMENT CENTER |
NPI Number: | 1508893579 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROGER JAMES MILLER (PRESIDENT., JITC) |
Mailing Address: | 2950 Halcyon Lane Suite706 Jacksonville |
State: | FL US |
Postal Code: | 32223 |
Phone Number: | 9048801366 |
Fax Number: | 9048808038 |
NPI Enumeration Date: | 06/27/2006 |
NPI Last Update Date: | 03/31/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261Q00000X |
License Number: | ME0053960 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |