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General NPI Number Information
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NPI Number | 1669560256
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Entity Type | Organization
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Legal Business Name | SHANDS JACKSONVILLE MEDICAL CENTER INC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 655 W 8TH ST BASEMENT, ACC BLDG.
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-244-6690
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Fax | 904-244-4431
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Provider Business Mailing Address
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Address Line | 655 W 8TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-244-8675
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Fax | 904-244-4027
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Authorized Official
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Title or Position | VP OF FINANCE AND TREASURER
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Name | MR. MICHAEL E GLEASON
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Credential |
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Telephone | 904-244-8675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State | FL
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