MEDICARE: SPECIALTY HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	284300000X	Special Hospital	ARNP1519732	FL

General Provider Information

NPI Number	:	1508031055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY HOSPITAL

Provider Business Mailing Address
First Line	:	4901 RICHARD ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-7328
Country	:	US
Telephone Number	:	904-730-5874
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 RICHARD ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-7328
Country	:	US
Telephone Number	:	904-730-5874
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	KEVIN MCKEOWN
Credential	:
Telephone Number	:	904-702-6573

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	03/30/2022

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Directions to “SPECIALTY HOSPITAL ” Practice Location

Language	Start Address	Practice Location

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