NPIMap

Organization Active NPI

Shands Jacksonville Medical Center Inc

Doing business as Shands Jacksonville Renal Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1669560256
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
SHANDS JACKSONVILLE MEDICAL CENTER INC
Doing business as
Shands Jacksonville Renal Dialysis
Practice address
655 W 8TH St
Basement, Acc BLDG.
Jacksonville, FL 32209-6511
Phone
(904) 244-6690
Fax
(904) 244-4431
NPI assigned
Oct 10, 2006
Last updated
Jul 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SHANDS JACKSONVILLE MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Authorized official

Name
Mr. Michael E Gleason
Title
VP of Finance and Treasurer
Phone
(904) 244-8675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X FL Primary

Addresses

Primary practice location

655 W 8TH St
Basement, Acc BLDG.
Jacksonville, FL 32209-6511

Mailing address

655 W 8TH St
Jacksonville, FL 32209-6511
Phone (904) 244-8675

Other names 1

  • Shands Jacksonville Renal Dialysis Doing business as

National Provider Directory

National Provider Directory
Part of
Shands Jacksonville Medical

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

655 W 8th St
Bsmt Acc
Jacksonville, FL 32209
Phone (904) 244-6690

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1669560256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-244-8675",
            "fax_number": "904-244-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "address_2": "BASEMENT, ACC BLDG.",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-244-6690",
            "fax_number": "904-244-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANDS JACKSONVILLE MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHANDS JACKSONVILLE MEDICAL CENTER, INC.",
        "enumeration_date": "2006-10-10",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "GLEASON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "VP OF FINANCE AND TREASURER",
        "authorized_official_telephone_number": "904-244-8675",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shands Jacksonville Renal Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 22, 2024; 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.