Provider Demographics
NPI:1346057718
Name:ST VINCENT'S FULL SERVICE URGENT CARE, LLC
Entity type:Organization
Organization Name:ST VINCENT'S FULL SERVICE URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-450-6004
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6004
Mailing Address - Fax:
Practice Address - Street 1:10058 BAYMEADOWS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7177
Practice Address - Country:US
Practice Address - Phone:904-450-8020
Practice Address - Fax:904-450-8004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST VINCENT'S FULL SERVICE URGENT CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care