NPIMap

Organization Active NPI

St Vincent'S Full Service Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1215414404
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
858 Monument Rd
Ste a
Jacksonville, FL 32225
Phone
(904) 450-6600
Fax
(904) 450-6369
NPI assigned
Jul 20, 2018
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 Specialists
Phone
(904) 450-6045

Specialties & licenses 1

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

Addresses

Primary practice location

858 Monument Rd
Ste a
Jacksonville, FL 32225

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623

Other identifiers 1

IdentifierTypeStateIssuer
007294307MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
St Vincents Full Service Ur11 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.

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": "1215414404",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "858 MONUMENT RD",
            "address_2": "STE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32225",
            "telephone_number": "904-450-6600",
            "fax_number": "904-450-6369"
        }
    ],
    "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 SPECIALISTS",
        "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": "007294307",
            "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.