Florida Department of Health

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

FLORIDA DEPARTMENT OF HEALTH

Practice address

5150 Timuquana Rd
Suite 9
Jacksonville, FL 32210-8959

Phone

(904) 253-1120

Fax

(904) 253-2514

NPI assigned

Aug 14, 2013

Organization subpart

Yes

Parent organization

FLORIDA DEPARTMENT OF HEALTHAs reported in NPPES

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

Authorized official

Name

Dr. Kelli T Wells, M.D.

Title

Director

Phone

(904) 253-2062

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Duval County Health Department Doing business as

Part of

Dept of Health Central Pharmacy

Locations

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

{
    "created_epoch": "1376438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376438400000",
    "number": "1104259019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 UNIVERSITY BLVD N",
            "address_2": "MC-75",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322119230",
            "telephone_number": "904-253-2062",
            "fax_number": "904-253-1942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 TIMUQUANA RD",
            "address_2": "SUITE 9",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322108959",
            "telephone_number": "904-253-1120",
            "fax_number": "904-253-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DEPARTMENT OF HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA DEPARTMENT OF HEALTH",
        "enumeration_date": "2013-08-14",
        "last_updated": "2013-08-14",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "KELLI",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-253-2062",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6905561-05",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6905561-08",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Duval County Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Florida Childrens Institute
• Florida Clinical Solutions Academy LLC
• Florida Dental Acquisitions P.a
• Florida Dental Team, LLC
• Florida Department of Health
• Florida Department of Health
• Florida Department of Health
• Florida Department of Health
• Florida Department of Health
• Florida Department of Health

• Federally Qualified Health Center (FQHC) in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Federally Qualified Health Center (FQHC) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; 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.