First Coast Orthopedic Associates LLC

Primary specialty

Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X

Legal business name

FIRST COAST ORTHOPEDIC ASSOCIATES LLC

Practice address

6067 Kennerly Rd
Jacksonville, FL 32216-4305

Phone

(904) 731-3131

NPI assigned

Jun 8, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Haissam Barakat

Title

Credentialing

Phone

(904) 962-6005

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1053005348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 WINDMOOR DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174240",
            "telephone_number": "904-388-4712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6067 KENNERLY RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164305",
            "telephone_number": "904-731-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COAST ORTHOPEDIC ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-08",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A",
        "authorized_official_last_name": "BARAKAT",
        "authorized_official_first_name": "HAISSAM",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "904-962-6005",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• First Coast Medical Associates LLC
• First Coast Medical Center Inc
• First Coast Medicine PLLC
• First Coast Midwifery Services LLC
• First Coast Nephrology Inc
• First Coast Orthopedic Center, LLC
• First Coast Pathology Associates, LLC
• First Coast Periodontics, PA
• First Coast Physical Medicine Inc
• First Coast Plastic Surgery PA

• Sports Medicine (Internal Medicine) Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Sports Medicine (Internal Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.