=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871762013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST LUKE'S EMERGENCY CARE GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2008
-----------------------------------------------------
Last Update Date | 05/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 SLEIMAN PKWY STE 210
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-8046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-716-0508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6700 COLLIER ROAD
-----------------------------------------------------
City | ST. AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32092-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-716-0508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KATHERINE CONSIDINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 904-716-0508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------