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General NPI Number Information
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NPI Number | 1629004114
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Entity Type | Organization
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Legal Business Name | PARK MEDICAL CENTER
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 06/10/2015
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Provider Practice Location Address
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Address Line | 847 PARK AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-4117
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Country | US
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Telephone | 904-264-4541
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Fax | 904-278-2709
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Provider Business Mailing Address
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Address Line | 847 PARK AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-4117
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Country | US
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Telephone | 904-264-4541
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Fax | 904-278-2709
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM R THOMPSON JR.
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Credential | M.D.
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Telephone | 904-264-4541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0012468
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License Number State | FL
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