=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366898165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORANGE PARK MEDICAL CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2016
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1883 KINGSLEY AVE
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32073-4479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-639-8500
-----------------------------------------------------
Fax | 904-639-2128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1883 KINGSLEY AVE
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32073-4479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-639-8500
-----------------------------------------------------
Fax | 904-639-2128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | EMILY LLOYD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 478-464-8140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273Y00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------