1366783441 NPI number — ST LUKES - ST VINCENTS HEALTHCARE

Table of content: (NPI 1366783441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366783441 NPI number — ST LUKES - ST VINCENTS HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKES - ST VINCENTS HEALTHCARE
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:
6
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:
1366783441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 BELFORT RD STE G361
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:
32216-1431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-450-6330
Provider Business Mailing Address Fax Number:
833-347-0804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4205 BELFORT RD STE 1003
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:
32216-5876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-450-6330
Provider Business Practice Location Address Fax Number:
833-347-0804
Provider Enumeration Date:
03/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CORNEJO
Authorized Official First Name:
COBA
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
803-463-5837

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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