Parkside Clinic, LLC

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

PARKSIDE CLINIC, LLC

Practice address

5600 Spring Park Rd
Suite 101
Jacksonville, FL 32216-5988

Phone

(904) 737-5000

Fax

(904) 737-5008

NPI assigned

Apr 7, 2015

Organization subpart

No

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

Authorized official

Name

Bruce Jarvie

Title

VP, Treasurer

Phone

(214) 379-3300

Specialties & licenses 3

Addresses

Other names 1

• MedMark Treatment Centers Jacksonville Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Opioid treatment program

Medicare-enrolled since Mar 28, 2023

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Zehra Cumber, DO

  • Family Medicine Physician
  • St Augustine, FL
  • NPI 1225051238
  NPD
• Ashley Nicole Blash

  • Addiction (Substance Use Disorder) Counselor
  • Jacksonville, FL
  • NPI 1174264527
  NPD (past)
• Shameka Nicole Guerrero, LPN

  • Licensed Practical Nurse
  • Jacksonville, FL
  • NPI 1134870967
  NPD (past)
• Camillia Mincey

  • Addiction (Substance Use Disorder) Counselor
  • Jacksonville, FL
  • NPI 1841931508
  NPD (past)
• Lawrence Walton

  • Addiction (Substance Use Disorder) Counselor
  • Jacksonville, FL
  • NPI 1528700119
  NPD (past)
• Mary Weiss, CAP

  • Addiction (Substance Use Disorder) Counselor
  • Jacksonville, FL
  • NPI 1497406474
  NPD (past)
• Daryl Whipple

  • Addiction (Substance Use Disorder) Counselor
  • Jacksonville, FL
  • NPI 1356083943
  NPD (past)

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1326434390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LAKEPOINTE DR STE 117",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576425",
            "telephone_number": "214-379-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 SPRING PARK RD",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165988",
            "telephone_number": "904-737-5000",
            "fax_number": "904-737-5008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-07",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "0416AD328501",
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedMark Treatment Centers Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brea Simone Parks, PHARMD
• Joseph William Parks IV, M.D.
• Monica Andrea Parks, RN
• Morgan Parks, PHYSICIAN ASSISTANT
• Tanya Parks, RN
• Mark Parkulo, MD
• Parkway Medicine LLC
• Parkway Plastic Surgery, P.L.
• Parmar Wellness LLC
• Neelam Parmar, LMHC

• Methadone Clinic in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Methadone Clinic in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.