Healthcare Provider Details

I. General information

NPI: 1407042013
Provider Name (Legal Business Name): HILLIARD MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3772 W 3RD ST
HILLIARD FL
32046-6846
US

IV. Provider business mailing address

3772 W 3RD ST
HILLIARD FL
32046-6846
US

V. Phone/Fax

Practice location:
  • Phone: 904-845-7419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME51340
License Number StateFL

VIII. Authorized Official

Name: MICHAEL SHARPE
Title or Position: OWNER
Credential: MD
Phone: 904-845-7419