Provider Demographics
NPI:1386036069
Name:GUIDEWELL EMERGENCY MEDICINE DOCTORS
Entity type:Organization
Organization Name:GUIDEWELL EMERGENCY MEDICINE DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-885-2413
Mailing Address - Street 1:4800 DEERWOOD CAMPUS PKWY FL DC1004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8317
Mailing Address - Country:US
Mailing Address - Phone:904-885-2413
Mailing Address - Fax:
Practice Address - Street 1:1706 N SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807
Practice Address - Country:US
Practice Address - Phone:904-424-3843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUIDEWELL EMERGENCY MEDICINE DOCTORS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-04
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIA890AMedicare UPIN