MEDICARE: ST VINCENTS AMBULATORY CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician	FL
2	207RC0000X	Cardiovascular Disease Physician
3	207RC0001X	Clinical Cardiac Electrophysiology Physician
4	207RC0001X	Clinical Cardiac Electrophysiology Physician	FL
5	207RP1001X	Pulmonary Disease Physician	FL
6	207T00000X	Neurological Surgery Physician	FL
7	207V00000X	Obstetrics & Gynecology Physician	FL
8	208600000X	Surgery Physician	FL
9	2086S0129X	Vascular Surgery Physician	FL
10	207T00000X	Neurological Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417987124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST VINCENTS AMBULATORY CARE INC

Provider Business Mailing Address
First Line	:	4500 SALISBURY RD STE 210
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-0968
Country	:	US
Telephone Number	:	904-308-7959
Fax Number	:	904-308-7938

Provider Business Practice Location Address
First Line	:	2 SHIRCLIFF WAY
Second Line	:	SUITE 600
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4742
Country	:	US
Telephone Number	:	904-308-6769
Fax Number	:	904-308-4072

Authorized Official
Title or Position	:	ENROLLMENT MANAGER
Name	:	MIRANDA HEMM
Credential	:
Telephone Number	:	904-450-6004

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	10/17/2022

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