Organization
ST VINCENTS MEDICAL CENTER INC
Active
Parent organization
ST VINCENTS MEDICAL CENTER INC
Other names
St Vincents Family Medicine Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST VINCENTS MEDICAL CENTER INC
Authorized official
GENE MIYAMOTO (COO)
(904) 308-1290
Entity
Organization
Contact information
Practice address
2627 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4712
(904) 308-7372
Mailing address
2627 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4712
(904) 308-7372
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057339600
—
FL
01
—
99612
BCBS
FL
Enumeration date
05/28/2006
Last updated
03/26/2010
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