1669556072 NPI number — ST. VINCENT'S MEDICAL CENTER, INC.

Table of content: (NPI 1669556072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669556072 NPI number — ST. VINCENT'S MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. VINCENT'S MEDICAL CENTER, 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:
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:
1669556072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 SHIRCLIFF WAY
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:
32204-4748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-308-7300
Provider Business Mailing Address Fax Number:
904-308-2947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4203 BELFORT RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-308-5600
Provider Business Practice Location Address Fax Number:
904-296-1589
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
JON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-308-8194

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  10D0645096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010073102 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: L8520 . This is a "BCBS FACILITY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010073102 . 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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