Provider Demographics
NPI:1902076524
Name:MONROSE CLINIC ASSOCIATES FOR PSYCHOLOGICAL MEDICINE
Entity Type:Organization
Organization Name:MONROSE CLINIC ASSOCIATES FOR PSYCHOLOGICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRISTS
Authorized Official - Prefix:DR
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-725-6463
Mailing Address - Street 1:3627 UNIVERSITY BLVD S STE 615
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-7401
Mailing Address - Country:US
Mailing Address - Phone:904-725-6463
Mailing Address - Fax:904-724-5006
Practice Address - Street 1:3627 UNIVERSITY BLVD SOUTH SUITE 615
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2721
Practice Address - Country:US
Practice Address - Phone:904-725-6463
Practice Address - Fax:904-724-5006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONROSE CLINIC ASSOCIATES FOR PSYCHOLOGICAL MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-11
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL081686072OtherTRICARE
FL081686072OtherCHAMPUS
FL4115015OtherAETNA
FL14203OtherBLUE CROSS
FL016627000OtherMAGELLAN
FL05770OtherWELLCARE
FL043765400Medicaid
FL05770OtherUNITED BEHAVIORAL HEALTH
FL081686072OtherFIRST HEALTH
FL088657OtherVALUE OPTIONS
GA256262286AOtherGA. MEDICAID
FL043765400Medicaid
FL081686072OtherCHAMPUS
FL4115015OtherAETNA