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General NPI Number Information
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NPI Number | 1518266626
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Entity Type | Organization
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Legal Business Name | VETERANS HEALTH CARE SYSTEMS NORTH FLORIDA
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 1015 ONTARIO ST
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City | JACKSONVILLE
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State | FL
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Zip | 32254-2073
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Country | US
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Telephone | 904-866-6914
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 ONTARIO ST
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City | JACKSONVILLE
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State | FL
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Zip | 32254-2073
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MIT WORK LEADER/MEDICAL SERVICES
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Name | MR. KEITH KELVIN PUGH
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Credential | RPSGT
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Telephone | 904-866-6914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 5281
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License Number State | NY
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