Healthcare Provider Details

I. General information

NPI: 1366898165
Provider Name (Legal Business Name): ORANGE PARK MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1883 KINGSLEY AVE
ORANGE PARK FL
32073-4479
US

IV. Provider business mailing address

1883 KINGSLEY AVE
ORANGE PARK FL
32073-4479
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-8500
  • Fax: 904-639-2128
Mailing address:
  • Phone: 904-639-8500
  • Fax: 904-639-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: EMILY LLOYD
Title or Position: CFO
Credential:
Phone: 478-464-8140