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Cogent Healthcare of Jacksonville, LLC

Organization Active NPI Internal Medicine Physician · Jacksonville, FL

NPI 1508449752 · NPPES record last updated May 4, 2021

Key facts

NPI
1508449752
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
COGENT HEALTHCARE OF JACKSONVILLE, LLC
Practice address
15255 Max Leggett Pkwy
Jacksonville, FL 32218-7273
Phone
(904) 383-1000
NPI assigned
May 4, 2021
Organization subpart
No

Authorized official

Name
Melissa Harlan
Title
Director
Phone
(615) 577-6340

Corporate family (same tax ID) 22

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

National Provider Directory

Tax ID family
Cogent Healthcare of Jacksonville LLC (23 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes

Addresses

Primary practice location

15255 Max Leggett Pkwy
Jacksonville, FL 32218-7273

Mailing address

5410 Maryland Way Ste 300
Brentwood, TN 37027-5339
Phone (615) 577-6340

Other identifiers

IdentifierTypeStateIssuer
001651532MedicaidFL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 4, 2021.

{
    "created_epoch": "1620086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620086400000",
    "number": "1508449752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5410 MARYLAND WAY STE 300",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275339",
            "telephone_number": "615-577-6340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15255 MAX LEGGETT PKWY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322187273",
            "telephone_number": "904-383-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COGENT HEALTHCARE OF JACKSONVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-04",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A",
        "authorized_official_last_name": "HARLAN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "615-577-6340"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001651532",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

All providers in Jacksonville, FL · Internal Medicine Physician in Florida

Sources for this page

Verify at the official NPI Registry.