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General NPI Number Information
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NPI Number | 1184305435
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Entity Type | Organization
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Legal Business Name | 904 HEALTH, INC
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Dates
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Enumeration Date | 07/28/2023
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 4427 EMERSON ST STE A
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City | JACKSONVILLE
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State | FL
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Zip | 32207-4969
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Country | US
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Telephone | 904-659-2475
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Fax |
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Provider Business Mailing Address
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Address Line | 221 N HOGAN ST STE 118
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City | JACKSONVILLE
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State | FL
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Zip | 32202-4201
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Country | US
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Telephone | 904-900-1513
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Fax | 904-575-4944
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAMES TARVER
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Credential |
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Telephone | 904-403-2079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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