Healthcare Provider Details

I. General information

NPI: 1003053695
Provider Name (Legal Business Name): FIRST CITY HOSPITALISTS GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD STE 300
ST AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

PO BOX 3123
ST AUGUSTINE FL
32085-3123
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-4082
  • Fax: 904-819-5156
Mailing address:
  • Phone: 615-260-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME 94505
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN EDWARD PRIOLEAU
Title or Position: OWNER
Credential: MD
Phone: 904-819-4082