1912219064 NPI number — EMED URGENT AND PRIMARY CARE INC

Table of content: (NPI 1912219064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912219064 NPI number — EMED URGENT AND PRIMARY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMED URGENT AND PRIMARY CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EMED MULTISPECIALTY GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912219064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2624 ATLANTIC BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-513-3240
Provider Business Mailing Address Fax Number:
904-379-2911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2624 ATLANTIC BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-513-3240
Provider Business Practice Location Address Fax Number:
904-379-2911
Provider Enumeration Date:
07/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PULIDO
Authorized Official First Name:
RENE
Authorized Official Middle Name:
U
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
904-513-3240

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 10D2009297 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002464700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9818064 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 148KP . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 004248300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 338970 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002464700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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