Healthcare Provider Details

I. General information

NPI: 1386077006
Provider Name (Legal Business Name): ST. VINCENT'S FIRST CARE-ORTEGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 ROOSEVELT BLVD
JACKSONVILLE FL
32244-2345
US

IV. Provider business mailing address

PO BOX 551281
JACKSONVILLE FL
32255-1281
US

V. Phone/Fax

Practice location:
  • Phone: 904-450-8100
  • Fax: 904-981-0051
Mailing address:
  • Phone: 904-450-8100
  • Fax: 904-981-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK REDDINGER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 904-379-1203