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General NPI Number Information
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NPI Number | 1245611037
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Entity Type | Organization
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Legal Business Name | AMELIA EXPRESS CARE, LLC
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 1987 S 8TH ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3071
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Country | US
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Telephone | 904-624-7003
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Fax | 904-212-1284
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Provider Business Mailing Address
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Address Line | 1987 S 8TH ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3071
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Country | US
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Telephone | 904-624-7003
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Fax | 904-212-1284
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Authorized Official
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Title or Position | MGR
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Name | JACOB LOGSDON
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Credential | PA
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Telephone | 904-624-7003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | OS10149
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License Number State | FL
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