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General NPI Number Information
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NPI Number | 1548580012
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Entity Type | Organization
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Legal Business Name | DE URGENT CARE JAX PA
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 13457 ATLANTIC BLVD SUITE 5
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City | JACKSONVILLE
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State | FL
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Zip | 32225-3293
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Country | US
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Telephone | 904-221-9110
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Fax |
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Provider Business Mailing Address
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Address Line | 13457 ATLANTIC BLVD SUITE 5
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City | JACKSONVILLE
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State | FL
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Zip | 32225-3293
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Country | US
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Telephone | 904-221-9110
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Fax | 904-220-9110
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAY HOLMES
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Credential | M.D.
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Telephone | 904-881-7754
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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 |
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License Number State |
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