Healthcare Provider Details

I. General information

NPI: 1194440289
Provider Name (Legal Business Name): FLAGLER PROFESSIONAL HEALTH CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ORTHOPAEDIC PL
SAINT AUGUSTINE FL
32086-4202
US

IV. Provider business mailing address

301 HEALTH PARK BLVD STE 216
SAINT AUGUSTINE FL
32086-5795
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-5213
  • Fax: 904-819-5159
Mailing address:
  • Phone: 904-819-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN WELLS FRANKS
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 904-819-4527