NPIMap

Organization Active NPI

Park Medical Center

  • Specialist
  • Orange Park, FL
National Provider Identifier
1629004114
Registry record updated Jun 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME0012468 Issued in FL
Legal business name
PARK MEDICAL CENTER
Practice address
847 Park Ave
Orange Park, FL 32073-4117
Phone
(904) 264-4541
Fax
(904) 278-2709
NPI assigned
Jun 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2015

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

Authorized official

Name
Dr. William R Thompson Jr., M.D.
Title
President
Phone
(904) 264-4541

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X ME0012468 FL Primary

Addresses

Primary practice location

847 Park Ave
Orange Park, FL 32073-4117

Mailing address

847 Park Ave
Orange Park, FL 32073-4117
Phone (904) 264-4541

Other identifiers 3

IdentifierTypeStateIssuer
1487621736OtherNPI
1013985035OtherNPI
1053388306OtherNPI

National Provider Directory

National Provider Directory

Locations

847 Park Ave
Orange Park, FL 32073
Phone (904) 264-4541

Practitioners & affiliated clinicians

Practitioners 2

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": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433894400000",
    "number": "1629004114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 PARK AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734117",
            "telephone_number": "904-264-4541",
            "fax_number": "904-278-2709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "847 PARK AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734117",
            "telephone_number": "904-264-4541",
            "fax_number": "904-278-2709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2015-06-10",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-264-4541",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME0012468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1487621736",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1013985035",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1053388306",
            "state": null
        }
    ],
    "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 10, 2015; 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.