MEDICARE: EMED URGENT CARE CENTER PA

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1679991459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMED URGENT CARE CENTER PA

Provider Business Mailing Address
First Line	:	2624 ATLANTIC BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3668
Country	:	US
Telephone Number	:	904-647-8576
Fax Number	:	904-306-9174

Provider Business Practice Location Address
First Line	:	2624 ATLANTIC BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3668
Country	:	US
Telephone Number	:	904-647-8576
Fax Number	:	904-306-9174

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RENE U PULIDO
Credential	:	MD
Telephone Number	:	904-647-8576

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	03/31/2014

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