NPIMap

Organization Active NPI

Memorial Family Practice Associates, LLC

  • Otolaryngology Physician
  • Orange Park, FL
National Provider Identifier
1619546850
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
MEMORIAL FAMILY PRACTICE ASSOCIATES, LLC
Practice address
1893 Kingsley Ave Ste C
Orange Park, FL 32073-4421
Phone
(904) 639-2260
NPI assigned
Jun 22, 2021
Last updated
Jun 22, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL FAMILY PRACTICE ASSOCIATES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Authorized official

Name
William Tedrick Johnson
Title
Vice President
Phone
(615) 372-3375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X Primary

Addresses

Primary practice location

1893 Kingsley Ave Ste C
Orange Park, FL 32073-4421

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4692
Phone (615) 372-5426

National Provider Directory

National Provider Directory
Tax ID family
Memorial Family Practice Associates LLC8 organizations share this tax ID, including this one
Part of
Memorial Family Practice Associates LLC

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1619546850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274692",
            "telephone_number": "615-372-5426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1893 KINGSLEY AVE STE C",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734421",
            "telephone_number": "904-639-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL FAMILY PRACTICE ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL FAMILY PRACTICE ASSOCIATES, LLC",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "TEDRICK",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-372-3375"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.