NPIMap

Organization Active NPI

State of Florida

  • Clinical Medical Laboratory
  • Jacksonville, FL
National Provider Identifier
1093138760
Registry record updated Jan 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
DI003429 Issued in FL
Legal business name
STATE OF FLORIDA
Practice address
1217 N Pearl St
Jacksonville, FL 32202-3926
Phone
(904) 791-1559
NPI assigned
Jan 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2014

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

Authorized official

Name
Dr. Dean Edward Willis, DRPH
Title
Director
Phone
(904) 791-1559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X DI003429 FL Primary

Addresses

Primary practice location

1217 N Pearl St
Jacksonville, FL 32202-3926

Mailing address

1217 N Pearl St
Jacksonville, FL 32202-3926
Phone (904) 791-1559

National Provider Directory

National Provider Directory
Tax ID family
Sunland Center Marianna15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1391040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391040000000",
    "number": "1093138760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 N PEARL ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322023926",
            "telephone_number": "904-791-1559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 N PEARL ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322023926",
            "telephone_number": "904-791-1559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF FLORIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-30",
        "last_updated": "2014-01-30",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-791-1559",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DRPH"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "DI003429",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.