Provider Demographics
NPI:1194440289
Name:FLAGLER PROFESSIONAL HEALTH CARE SERVICES, INC.
Entity type:Organization
Organization Name:FLAGLER PROFESSIONAL HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:FRANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-819-4527
Mailing Address - Street 1:301 HEALTH PARK BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5795
Mailing Address - Country:US
Mailing Address - Phone:904-819-5213
Mailing Address - Fax:
Practice Address - Street 1:1 ORTHOPAEDIC PL
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4202
Practice Address - Country:US
Practice Address - Phone:904-819-5213
Practice Address - Fax:904-819-5159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLAGLER PROFESSIONAL HEALTH CARE SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Multi-Specialty