NPIMap

Organization Active NPI

Southern Medical Clinic PA

  • Family Medicine Physician
  • Macclenny, FL
National Provider Identifier
1437214541
Registry record updated Mar 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME0047919 Issued in FL
Legal business name
SOUTHERN MEDICAL CLINIC PA
Practice address
32 S 5TH St
Macclenny, FL 32063-2302
Phone
(904) 259-9377
Fax
(904) 259-9949
NPI assigned
Dec 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2012

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

Authorized official

Name
Mrs. Kathleen Bridgeman
Title
President
Phone
(904) 259-9377

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X ME0047919 FL Primary

Addresses

Primary practice location

32 S 5TH St
Macclenny, FL 32063-2302

Mailing address

153 Laurina St
Jacksonville, FL 32216-9025
Phone (904) 259-9377

National Provider Directory

National Provider Directory

Locations

32 S 5th St
Macclenny, FL 32063
Phone (904) 259-5929

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331596800000",
    "number": "1437214541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 LAURINA ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322169025",
            "telephone_number": "904-259-9377",
            "fax_number": "904-259-9949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 S 5TH ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632302",
            "telephone_number": "904-259-9377",
            "fax_number": "904-259-9949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MEDICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2012-03-13",
        "status": "A",
        "authorized_official_last_name": "BRIDGEMAN",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-259-9377",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0047919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macclenny, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; 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.