Healthcare Provider Details

I. General information

NPI: 1245983568
Provider Name (Legal Business Name): VOLUNTEERS IN MEDICINE JACKSONVILLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 EAST DUVAL STREET
JACKSONVILLE FL
32202
US

IV. Provider business mailing address

41 EAST DUVAL STREET
JACKSONVILLE FL
32202
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-2766
  • Fax: 904-549-8300
Mailing address:
  • Phone: 904-399-2766
  • Fax: 904-549-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER RYAN
Title or Position: CEO
Credential:
Phone: 904-399-2766