Healthcare Provider Details

I. General information

NPI: 1952738981
Provider Name (Legal Business Name): RIVER CITY PRIMARY & URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 PARK AVE
ORANGE PARK FL
32073-4120
US

IV. Provider business mailing address

6947 MERRILL RD
JACKSONVILLE FL
32277-2684
US

V. Phone/Fax

Practice location:
  • Phone: 904-435-0799
  • Fax: 904-435-0797
Mailing address:
  • Phone: 904-743-2222
  • Fax: 904-743-3087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME121788
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME121788
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME57227
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME121788
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME57227
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME121788
License Number StateFL

VIII. Authorized Official

Name: DR. VIPUL R PATEL
Title or Position: DIRECTOR
Credential:
Phone: 904-487-8320