Active NPI
Florida Department of Health
- Federally Qualified Health Center (FQHC)
- Jacksonville, FL
National Provider Identifier
1205013232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- Legal business name
- FLORIDA DEPARTMENT OF HEALTH
- Practice address
- 120 King St
MC 75
Jacksonville, FL 32204-2410 - Phone
- (904) 253-2785
- Fax
- (904) 253-1961
- NPI assigned
- Jan 22, 2008
- Organization subpart
- Yes
- Parent organization
- FLORIDA DEPARTMENT OF HEALTH
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kelli T Wells, M.D.
- Title
- Director
- Phone
- (904) 253-2062
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | FL | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Primary |
Addresses
Primary practice location
120 King St
MC 75
Jacksonville, FL 32204-2410
Mailing address
900 University Blvd., MC 75
MC 75
Jacksonville, FL 32211
Phone (904) 253-2062
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6905561-01 | Medicaid | FL | |
| 6905561-00 | Medicaid | FL |
Other names 1
- Duval County Health Department
National Provider Directory
National Provider Directory- Part of
- Dept of Health Central Pharmacy
Locations
120 King St
#75
Jacksonville, FL 32204
Phone (904) 253-2785
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200960000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1450656000000",
"number": "1205013232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 UNIVERSITY BLVD., MC 75",
"address_2": "MC 75",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32211",
"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": "120 KING ST",
"address_2": "MC 75",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322042410",
"telephone_number": "904-253-2785",
"fax_number": "904-253-1961"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FLORIDA DEPARTMENT OF HEALTH",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FLORIDA DEPARTMENT OF HEALTH",
"enumeration_date": "2008-01-22",
"last_updated": "2015-12-21",
"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_credential": "M.D."
},
"taxonomies": [
{
"code": "251K00000X",
"taxonomy_group": "",
"desc": "Public Health or Welfare",
"state": "FL",
"license": null,
"primary": false
},
{
"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": "6905561-01",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6905561-00",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Duval County Health Department",
"code": "3",
"type": "Doing Business As"
}
]
}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 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.