Healthcare Provider Details

I. General information

NPI: 1124050711
Provider Name (Legal Business Name): MEADOWLANDS MEDICAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 KINGSLEY AVE BLDG 1
ORANGE PARK FL
32073-4535
US

IV. Provider business mailing address

1871 SENTRY OAK CT
FLEMING ISLAND FL
32003-3775
US

V. Phone/Fax

Practice location:
  • Phone: 904-706-1636
  • Fax: 904-592-1322
Mailing address:
  • Phone: 904-706-1636
  • Fax: 904-592-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME70009
License Number StateFL

VIII. Authorized Official

Name: MARC LOUIS ALESSANDRIA
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 904-706-1636