1831454248 NPI number — HOLY TRINITY COMMUNITY MEDICAL CENTER

Table of content: MADISON MARIE ASHLOCK (NPI 1780392753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831454248 NPI number — HOLY TRINITY COMMUNITY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLY TRINITY COMMUNITY MEDICAL CENTER
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:
Provider Other Organization Name Type Code:
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:
1831454248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4001 CONFEDERATE POINT RD
Provider Second Line Business Mailing Address:
SUITE # 2
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32210-5459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-908-0046
Provider Business Mailing Address Fax Number:
904-908-0329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 CONFEDERATE POINT RD
Provider Second Line Business Practice Location Address:
SUITE # 2
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32210-5459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-908-0046
Provider Business Practice Location Address Fax Number:
904-908-0329
Provider Enumeration Date:
07/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ACEVEDO
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
LISA
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
904-908-0046

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 277361600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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