NPIMap

Organization Active NPI

Concentra Medical Center-Jax Northside

  • Health Service Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1629264288
Registry record updated Sep 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
CONCENTRA MEDICAL CENTER-JAX NORTHSIDE
Practice address
1215 Dunn Ave
Ste. 7
Jacksonville, FL 32218-6330
Phone
(904) 757-5656
Fax
(904) 757-5650
NPI assigned
Sep 18, 2007
Last updated
Sep 18, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2007

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

Authorized official

Name
Dr. Tom Fogarty, MD
Title
Evp, Cmo
Phone
(800) 232-3550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

1215 Dunn Ave
Ste. 7
Jacksonville, FL 32218-6330

Mailing address

5080 Spectrum Dr
Ste. 1200 West Tower
Addison, TX 75001-4648
Phone (800) 232-3550

National Provider Directory

National Provider Directory
Tax ID family
Concentra Urgent Care - Sunshine Miami293 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1215 Dunn Ave
Ste 7
Jacksonville, FL 32218

NPI Registry JSON

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190073600000",
    "number": "1629264288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5080 SPECTRUM DR",
            "address_2": "STE. 1200 WEST TOWER",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750014648",
            "telephone_number": "800-232-3550",
            "fax_number": "800-401-6728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 DUNN AVE",
            "address_2": "STE. 7",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322186330",
            "telephone_number": "904-757-5656",
            "fax_number": "904-757-5650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCENTRA MEDICAL CENTER-JAX NORTHSIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2007-09-18",
        "status": "A",
        "authorized_official_last_name": "FOGARTY",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "EVP, CMO",
        "authorized_official_telephone_number": "800-232-3550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Sep 18, 2007; 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.