Jacksonville Beach Psychiatric Service

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

JACKSONVILLE BEACH PSYCHIATRIC SERVICE

Practice address

390 16TH Ave S
Jacksonville, FL 32250-4961

Phone

(954) 746-8232

NPI assigned

Dec 29, 2016

Organization subpart

No

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

Authorized official

Name

Kyle Marcotte

Title

Owner

Phone

(954) 746-8232

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1482969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483401600000",
    "number": "1922543941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 16TH AVE S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322504961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 16TH AVE S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322504961",
            "telephone_number": "954-746-8232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE BEACH PSYCHIATRIC SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-29",
        "last_updated": "2017-01-03",
        "status": "A",
        "authorized_official_last_name": "MARCOTTE",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-746-8232"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2017; 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.