NPIMap

Organization Active NPI

St Vincent'S Full Service Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1467939660
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
6488 103Rd St
Ste a
Jacksonville, FL 32210
Phone
(904) 450-6800
NPI assigned
Jul 20, 2018
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Andrea Mendoza
Title
Chief Revenue Cycle Specialists
Phone
(904) 450-6045

Corporate family (same tax ID) 10

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2151349St Vincents Full Service Urgent Care LLC6488 103Rd Ave Ste a, Jacksonville, FL 32210Certificate of waiverJul 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
St Vincents Full Service Ur (11 organizations share this tax ID)

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

6488 103Rd St
Ste a
Jacksonville, FL 32210

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
007294305MedicaidFL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 20, 2018.

{
    "created_epoch": "1532044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532044800000",
    "number": "1467939660",
    "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": "6488 103RD ST",
            "address_2": "STE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32210",
            "telephone_number": "904-450-6800"
        }
    ],
    "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": "007294305",
            "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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.