1942515804 NPI number — 30 MINUTE MEDICAL PRIMARY CARE

Table of content: DR. FRANCIS JOSEPH KENEALLY JR. DMD (NPI 1326168147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942515804 NPI number — 30 MINUTE MEDICAL PRIMARY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
30 MINUTE MEDICAL PRIMARY CARE
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:
1942515804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8540 ARGYLE FOREST BLVD.
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32244-6314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-777-1650
Provider Business Mailing Address Fax Number:
904-777-1665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8540 ARGYLE FOREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32244-6702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-777-1650
Provider Business Practice Location Address Fax Number:
904-777-1665
Provider Enumeration Date:
08/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VULTAGGIO
Authorized Official First Name:
BIAGIO
Authorized Official Middle Name:
V
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
904-777-1650

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME96271 , 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)





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