NPIMap

Organization Active NPI

Branch Medical Clinic Jacksonville

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1104331065
Registry record updated Dec 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
BRANCH MEDICAL CLINIC JACKSONVILLE
Practice address
964 Ajax St
Jacksonville, FL 32214-0001
Phone
(904) 546-7094
NPI assigned
Dec 13, 2017
Organization subpart
Yes
Parent organization
NAVAL HOSPITAL JACKSONVILLEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2017

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

Authorized official

Name
William M Condon
Title
Bumed Ubo
Phone
(240) 401-3643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X Primary

Addresses

Primary practice location

964 Ajax St
Jacksonville, FL 32214-0001

Mailing address

2080 Child St
Jacksonville, FL 32214-5005

National Provider Directory

National Provider Directory
Tax ID family
Branch Medical Clinic Albany13 organizations share this tax ID, including this one
Part of
Branch Medical Clinic Albany

Other organizations with this tax ID 12

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

Locations

964 Ajax St
Jacksonville, FL 32214
Phone (904) 546-7000

NPI Registry JSON

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

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513123200000",
    "number": "1104331065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322145005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "964 AJAX ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322140001",
            "telephone_number": "904-546-7094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANCH MEDICAL CLINIC JACKSONVILLE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NAVAL HOSPITAL JACKSONVILLE",
        "enumeration_date": "2017-12-13",
        "last_updated": "2017-12-13",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUMED UBO",
        "authorized_official_telephone_number": "240-401-3643"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "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 Dec 13, 2017; 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.