NPIMap

Organization Active NPI

Florida Department of Health

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, FL
National Provider Identifier
1780017699
Registry record updated Aug 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FLORIDA DEPARTMENT OF HEALTH
Practice address
3225 University Blvd S
Suite 101
Jacksonville, FL 32216-2762
Phone
(904) 253-1120
Fax
(904) 253-2514
NPI assigned
Aug 14, 2013
Organization subpart
Yes
Parent organization
FLORIDA DEPARTMENT OF HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2013

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

Authorized official

Name
Dr. Kelli T Wells, M.D.
Title
Director
Phone
(904) 253-2062

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3225 University Blvd S
Suite 101
Jacksonville, FL 32216-2762

Mailing address

900 University Blvd N
MC-75
Jacksonville, FL 32211-9230
Phone (904) 253-2062

Other identifiers 2

IdentifierTypeStateIssuer
6905561-04MedicaidFL
6905561-09MedicaidFL

Other names 1

  • Duval County Health Department Doing business as

National Provider Directory

National Provider Directory
Part of
Dept of Health Central Pharmacy

NPI Registry JSON

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

{
    "created_epoch": "1376438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376438400000",
    "number": "1780017699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 UNIVERSITY BLVD N",
            "address_2": "MC-75",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322119230",
            "telephone_number": "904-253-2062",
            "fax_number": "904-253-1942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 UNIVERSITY BLVD S",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162762",
            "telephone_number": "904-253-1120",
            "fax_number": "904-253-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DEPARTMENT OF HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA DEPARTMENT OF HEALTH",
        "enumeration_date": "2013-08-14",
        "last_updated": "2013-08-14",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "KELLI",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-253-2062",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6905561-04",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6905561-09",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Duval County Health Department",
            "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 Aug 14, 2013; 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.