Provider Demographics
NPI:1447306410
Name:NORTH FLORIDA ADDICTION MEDICINE
Entity type:Organization
Organization Name:NORTH FLORIDA ADDICTION MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BILLING/COLLECTIONS
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-691-0856
Mailing Address - Street 1:1100 PARK CENTRAL BLVD S
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2218
Mailing Address - Country:US
Mailing Address - Phone:954-691-0856
Mailing Address - Fax:954-691-0834
Practice Address - Street 1:1900 CORPORATE SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1941
Practice Address - Country:US
Practice Address - Phone:954-691-0856
Practice Address - Fax:954-691-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8000-27017291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty