Healthcare Provider Details

I. General information

NPI: 1689611501
Provider Name (Legal Business Name): ORANGE PARK MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-8500
  • Fax: 904-276-8610
Mailing address:
  • Phone: 904-276-8500
  • Fax: 904-276-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JAY PETTUS
Title or Position: CFO
Credential:
Phone: 904-639-8500