NPIMap

Organization Active NPI

St Vincent's Full Service Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1023595345
Registry record updated Jul 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
ST VINCENT'S FULL SERVICE URGENT CARE, LLC
Practice address
7963 Normandy Blvd
Jacksonville, FL 32221-6640
Phone
(904) 783-2405
Fax
(904) 781-6080
NPI assigned
Jul 20, 2018
Last updated
Jul 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2018

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

Authorized official

Name
Andrea Mendoza
Title
Chief Revenue Cycle Spec.
Phone
(904) 450-6045

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

7963 Normandy Blvd
Jacksonville, FL 32221-6640

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623
Phone (904) 450-6045

Other identifiers 1

IdentifierTypeStateIssuer
007294300MedicaidFL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2068554St Vincents Full Service Urgent Care LLC7963 Normandy Blvd, Jacksonville, FL 32221Certificate of waiverNov 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
St Vincent's First Care-Normandy11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7963 Normandy Blvd
Jacksonville, FL 32221
Phone (904) 379-1203

NPI Registry JSON

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

{
    "created_epoch": "1532044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532044800000",
    "number": "1023595345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-450-6045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7963 NORMANDY BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322216640",
            "telephone_number": "904-783-2405",
            "fax_number": "904-781-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENT'S FULL SERVICE URGENT CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-20",
        "last_updated": "2018-07-20",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CHIEF REVENUE CYCLE SPEC.",
        "authorized_official_telephone_number": "904-450-6045"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007294300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.