NPIMap

Organization Active NPI

Naval Hospital Jacksonville

  • Emergency Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1265411383
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
J0352 Issued in TX
Legal business name
NAVAL HOSPITAL JACKSONVILLE
Practice address
2080 Child St
Jacksonville, FL 32214-5005
Phone
(904) 542-7787
Fax
(904) 542-7651
NPI assigned
Jan 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Authorized official

Name
Dr. Elaine Wagner, DENTIST
Title
Executive Officer
Phone
(904) 542-7312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X J0352 TX Primary

Addresses

Primary practice location

2080 Child St
Jacksonville, FL 32214-5005

Mailing address

2080 Child St
Jacksonville, FL 32214-5005
Phone (904) 542-7787

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1265411383",
    "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",
            "telephone_number": "904-542-7787",
            "fax_number": "904-542-7651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322145005",
            "telephone_number": "904-542-7787",
            "fax_number": "904-542-7651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAVAL HOSPITAL JACKSONVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-17",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "904-542-7312",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DENTIST"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "J0352",
            "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 Jun 18, 2008; 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.