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NPI Code Detail

MEDICARE: PARK MEDICAL CENTER

MEDICARE: PARK MEDICAL CENTER
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
1174400000XSpecialistME0012468FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11487621736OTHERNPI
21013985035OTHERNPI
31053388306OTHERNPI

General Provider Information

NPI Number : 1629004114
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARK MEDICAL CENTER
Provider Business Mailing Address
First Line : 847 PARK AVE
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-4117
Country : US
Telephone Number : 904-264-4541
Fax Number : 904-278-2709
Provider Business Practice Location Address
First Line : 847 PARK AVE
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-4117
Country : US
Telephone Number : 904-264-4541
Fax Number : 904-278-2709
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIAM R THOMPSON JR.
Credential : M.D.
Telephone Number : 904-264-4541
Provider Enumeration Date : 06/25/2006
Last Update Date : 06/10/2015

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Directions to “PARK MEDICAL CENTER ” Practice Location

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