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Kenneth L Maskell

Hospitalist

Allopathic & Osteopathic Physicians

820 Prudential Dr Ste 304, Jacksonville, FL 32207-8205

(904) 202-3860 (904) 202-2092

PECOS Enrollment

This provider is enrolled in PECOS as KENNETH MASKELL.

Based on the most recent information from CMS, provider Kenneth L Maskell 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 yesterday at 11:21 AM.

Profile Details

Provider ID
1356737308
Provider Type
Individual
Full Name
Maskell, Kenneth L
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
4/7/2015
Last Updated
3/7/2025

Contact Information

Practice Location

820 Prudential Dr Ste 304, Jacksonville, FL 32207-8205

(904) 202-3860

(904) 202-3846

Mailing Location

PO Box 746638, Atlanta, GA 30374-6638

(904) 202-2092

(904) 376-4075

Provider Taxonomies

Code	Description	License
Code 208M00000X Primary	Description Hospitalist Allopathic & Osteopathic Physicians	License ME170543 Florida
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License ME170543 Florida
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License 036145978 Illinois
Code 208M00000X	Description Hospitalist Allopathic & Osteopathic Physicians	License 036145978 Illinois

Provider Identifiers

ID	Description	Issuer
ID 036145978	Description Medicaid	Issuer Unlisted Illinois

Kenneth L Maskell

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

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Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Wang, Crystal

Bahloul, Rami

Boland, Annemarie Jin

Rotko, Tatjana A

Mccarthy, Anna M

Elder, Joshua S

Saenz Maisonet, Jean Franc

Rathod, Sandeep Anil

Tran, Phuc V.

Kawaf, Layla