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Contact Information

CRG34AH01 LLC
4540 SOUTHSIDE BLVD STE 202
JACKSONVILLE, FL32216-5488
 Phone: 904-503-1065
 Fax: 904-374-6075
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
 

Brain Injury Medicine

2084P0301X 86 Physician/Neuropsychiatry
 

Chiropractor

111N00000X 35 Chiropractic
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Orthopaedic Surgery of the Spine

207XS0117X 02 Physician/General Surgery
 

Orthopaedic Trauma

207XX0801X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for CRG34AH01 LLC

NPI Number 1265284574
LBN Legal business name CRG34AH01 LLC
Authorized official LOGAN MORRIS - (MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/02/2024
Last updated 04/02/2024 - About 2 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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