Provider Demographics
NPI:1871924258
Name:ST. VINCENT'S FIRST CARE
Entity type:Organization
Organization Name:ST. VINCENT'S FIRST CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL 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:904-738-5177
Mailing Address - Street 1:8323 RAMONA BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-1386
Mailing Address - Country:US
Mailing Address - Phone:904-379-1203
Mailing Address - Fax:904-379-9282
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:904-379-1203
Practice Address - Fax:904-379-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEXEMPT HOSPITAL OWNE363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040JOtherBLUE CROSS FLORIDA
FL007294300Medicaid
FL007293401Medicaid
FL007294300Medicaid