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General NPI Number Information
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NPI Number | 1669556072
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Entity Type | Organization
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Legal Business Name | ST. VINCENT'S MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 4203 BELFORT RD SUITE 106
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1409
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Country | US
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Telephone | 904-308-5600
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Fax | 904-296-1589
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Provider Business Mailing Address
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Address Line | 1 SHIRCLIFF WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4748
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Country | US
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Telephone | 904-308-7300
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Fax | 904-308-2947
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Authorized Official
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Title or Position | PRESIDENT
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Name | JON COOPER
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Credential |
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Telephone | 904-308-8194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D0645096
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License Number State | FL
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