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General NPI Number Information
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NPI Number | 1649450834
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Entity Type | Organization
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Legal Business Name | MAGNOLIA URGENT CARE, PA
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 3185 HIGHWAY 17
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-9371
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Country | US
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Telephone | 904-284-4222
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Fax | 904-284-2025
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Provider Business Mailing Address
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Address Line | 3185 HIGHWAY 17
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-9371
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Country | US
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Telephone | 904-284-4222
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Fax | 904-284-2025
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM A JACOBS
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Credential | MD
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Telephone | 904-284-4222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME0047311
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License Number State | FL
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