Healthcare Provider Details

I. General information

NPI: 1831676188
Provider Name (Legal Business Name): ST VINCENT'S FULL SERVICE URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 COUNTY ROAD 210 W STE 100
SAINT JOHNS FL
32259-2063
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 904-450-8400
  • Fax: 904-230-1066
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA MENDOZA
Title or Position: CHIEF REVENUE CYCLE SPECIALISTS
Credential:
Phone: 904-450-6045