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John Louis Mazzella

Radiology

Allopathic & Osteopathic Physicians

4201 Belfort Rd, Jacksonville, FL 32216-1431

PECOS Enrollment

This provider is enrolled in PECOS as JOHN MAZZELLA.

Based on the most recent information from CMS, provider John Louis Mazzella is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1588610026
Provider Type
Individual
Full Name
Mazzella, John Louis
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
5/26/2006
Last Updated
8/14/2023

Contact Information

Practice Location

4201 Belfort Rd, Jacksonville, FL 32216-1431

(904) 296-3886

(904) 551-0709

Mailing Location

PO Box 161180, Altamonte Springs, FL 32716-1180

(904) 388-6949

(904) 388-1841

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License ME89003 Florida

Provider Identifiers

ID	Description	Issuer
ID 270834500	Description Medicaid	Issuer Unlisted Florida

John Louis Mazzella

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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