Pro-Med Collectors LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRO-MED COLLECTORS LLC

Doing business as

ProMed Clinic

Practice address

1907 Atlantic Blvd
Jacksonville, FL 32207-3466

Phone

(904) 388-4712

NPI assigned

Jan 2, 2014

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

President

Phone

(904) 962-6005

Specialties & licenses 3

Addresses

Other names 1

• ProMed Clinic Doing business as

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

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421193600000",
    "number": "1629499090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1462 FLANDERS RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322071904",
            "telephone_number": "904-388-4712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 ATLANTIC BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322073466",
            "telephone_number": "904-388-4712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-MED COLLECTORS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-02",
        "last_updated": "2015-01-14",
        "status": "A",
        "authorized_official_last_name": "BARAKAT",
        "authorized_official_first_name": "HAISSAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-962-6005",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProMed Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Wende M Probst, ARNP
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• Charles Daniel Procter Sr., MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; 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.