Healthcare Provider Details

I. General information

NPI: 1033736574
Provider Name (Legal Business Name): ST. JOHN'S INTEGRATED HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11363 SAN JOSE BLVD STE 102B
JACKSONVILLE FL
32223-7958
US

IV. Provider business mailing address

11363 SAN JOSE BLVD STE 102
JACKSONVILLE FL
32223-7958
US

V. Phone/Fax

Practice location:
  • Phone: 904-288-8993
  • Fax: 904-288-8995
Mailing address:
  • Phone: 904-288-8993
  • Fax: 904-288-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM STEPHEN FOLAND
Title or Position: OWNER
Credential: DC
Phone: 904-288-8993