MEDICARE: AMELIA URGENT CARE LLC

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	261QC0050X	Critical Access Hospital Clinic/Center	OS6933	FL

General Provider Information

NPI Number	:	1720417884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMELIA URGENT CARE LLC

Provider Business Mailing Address
First Line	:	510 AIRPORT CENTER DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7260
Country	:	US
Telephone Number	:	904-696-0055
Fax Number	:	904-551-6533

Provider Business Practice Location Address
First Line	:	96279 BRADY POINT RD
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-7076
Country	:	US
Telephone Number	:	904-321-1177
Fax Number	:	904-321-0016

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	DR. DANIEL MATRICIA
Credential	:	D.O.
Telephone Number	:	904-583-3016

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	11/08/2013

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