MEDICARE: EMERGENCY PHYSICIANS OF ST. JOHNS COUNTY

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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CI9014	OTHER	FL	RR MCR GROUP
2	34811	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1801881818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENCY PHYSICIANS OF ST. JOHNS COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 863639
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-3639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 HEALTH PARK BLVD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-5784
Country	:	US
Telephone Number	:	904-826-4700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. JAY EDELBERG
Credential	:	MD
Telephone Number	:	888-680-6067

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	08/22/2020

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Directions to “EMERGENCY PHYSICIANS OF ST. JOHNS COUNTY ” Practice Location

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