Provider Demographics
NPI:1386077006
Name:ST. VINCENT'S FIRST CARE-ORTEGA
Entity type:Organization
Organization Name:ST. VINCENT'S FIRST CARE-ORTEGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-379-1203
Mailing Address - Street 1:PO BOX 551281
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1281
Mailing Address - Country:US
Mailing Address - Phone:904-450-8100
Mailing Address - Fax:904-981-0051
Practice Address - Street 1:5501 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-2345
Practice Address - Country:US
Practice Address - Phone:904-450-8100
Practice Address - Fax:904-981-0051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT'S FIRST CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine