St Vincents Medical Center Inc
Organization Active NPI Primary Care Clinic/Center · Jacksonville, FL
NPI 1427005131 · NPPES record last updated Mar 26, 2010
Key facts
- NPI
- 1427005131
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- ST VINCENTS MEDICAL CENTER INC
- Practice address
- 2627 Riverside Ave
Jacksonville, FL 32204-4712 - Phone
- (904) 308-7372
- NPI assigned
- May 28, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- ST VINCENTS MEDICAL CENTER INC
Authorized official
- Name
- Gene Miyamoto
- Title
- Coo
- Phone
- (904) 308-1290
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Member of 1
Practitioners 40
-
Danielle Marie Carter, M.D.
-
Jan Dela Cruz, DO
-
Sonya Jean Dominguez, M.D.
-
Hanain Fazal, DO
-
Bashyam Iyengar, MD
-
Sara Kramer-Wallace, ARNP
-
Jason W. Largen, MD
-
David Alan McInnes, M.D.
-
Donna Robin Potts, M.D.
-
Jennifer R Snell, MD
-
Terrence L Soldo, DO
-
Suny Mariel Caminero, M.D.
-
Regina M George, NP
-
Daina Paige Greene, M.D.
-
Helena Jane Karnani, M.D.
-
Julie Amelia Kellogg, M.D.
-
Maria Mahmoodi, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031119000296 | FL | Part B Supplier - Clinic/Group Practice | 0244144558 |
Receives reassigned benefits from 37 practitioners Practice locations: Jacksonville, FL |
National Provider Directory
- Tax ID family
- Margaret H Duffy MD
- Part of
- Margaret H Duffy MD
Locations
2708 Saint Johns Ave
Jacksonville, FL 32205
Phone (904) 308-7372
1786 Blanding Blvd
Ste 11
Middleburg, FL 32068
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
2627 Riverside Ave
Jacksonville, FL 32204-4712
Mailing address
2627 Riverside Ave
Jacksonville, FL 32204-4712
Phone (904) 308-7372
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 057339600 | Medicaid | FL | |
| 99612 | Other | FL | BCBS |
Other names
- St Vincents Family Medicine Center
Other providers in Jacksonville, FL
- St Vincent'S Full Service Urgent Care, LLC
- St Vincents Ambulatory Care Inc
- St Vincents Ambulatory Care Inc
- St Vincents Electrocardiography, Inc
- St Vincents Medical Center Inc
- St Vincents Medical Center Inc
- St Vincents Pathology Associates PA
- St Vincents Physician Enterprise Inc
- Matthew Tyler St. George
- Teresa Marie St. John
All providers in Jacksonville, FL · Primary Care Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.