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1134117575

NPI Code Detail

MEDICARE: ST VINCENTS MEDICAL CENTER INC

MEDICARE: ST VINCENTS MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	4376	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	108	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134117575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST VINCENTS MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	4205 BELFORT ROAD
Second Line	:	JAB # 4020
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1475
Country	:	US
Telephone Number	:	904-450-6020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SHIRCLIFF WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4748
Country	:	US
Telephone Number	:	904-308-7300
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	COBA SUSAN CORNEJO
Credential	:
Telephone Number	:	850-416-6206

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	03/17/2026

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Directions to “ST VINCENTS MEDICAL CENTER INC ” Practice Location

Language	Start Address	Practice Location

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