Healthcare Provider Details

I. General information

NPI: 1821186313
Provider Name (Legal Business Name): SHANDS JACKSONVILLE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/22/2024
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-8675
  • Fax: 904-244-4027
Mailing address:
  • Phone: 904-244-8675
  • Fax: 904-244-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4063
License Number StateFL

VIII. Authorized Official

Name: MR. DEAN COCCHI
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 904-244-5013