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PARK MEDICAL CENTER NPI 1629004114


NPI Information

NPI: 1629004114
Provider Name: PARK MEDICAL CENTER
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
847 PARK AVE
ORANGE PARK, FL
ZIP 32073
Phone: (904) 264-4541
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PARK MEDICAL CENTER is a specialist in Orange Park, FL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. PARK MEDICAL CENTER NPI is 1629004114. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

847 PARK AVE
ORANGE PARK, FL
ZIP 32073-117
Phone: (904) 264-4541
Fax: (904) 278-2709

The provider's authorized official is William R Thompson .
The authorized official title is President and has the following contact phone number (904) 264-4541.

The enumeration date for this NPI number is 6/25/2006 and was last updated on 6/10/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistME0012468FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100471MEDICARE ID-TYPE UNSPECIFIEDFLORIDA
21053388306OTHERNPI
31013985035OTHERNPI
41487621736OTHERNPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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