MAYO CLINIC JACKSONVILLE (NPI# 1174143986) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174143986 |
| Entity Type | Organization |
| Organization Name | MAYO CLINIC JACKSONVILLE |
| Other Organization Name | MAYO CLINIC JACKSONVILLE ADVANCED CARE AT HOME |
| Practice Address |
4500 San Pablo Rd S Jacksonville FL 32224-1865 |
| Practice Telephone | 9049532000 |
| Mailing Telephone | 5072660349 |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2020-11-09 |
| Authorized Official Name | ALICE RIGDON (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 9049534388 |
| Is Organization Subpart | Y |
| Parent Organization Name | MAYO CLINIC JACKSONVILLE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Mayo Clinic Jacksonville advanced care at home | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265097513 | Mayo Clinic Jacksonville | Ambulance | 13970 Zumbro Dr, Jacksonville, FL 32224 | 2019-05-02 |
| 1578037891 | Mayo Clinic Jacksonville | Durable Medical Equipment & Medical Supplies | 7826 Ozark Dr, Jacksonville, FL 32256-5839 | 2019-01-21 |
| 1790772317 | Mayo Clinic Jacksonville | Durable Medical Equipment & Medical Supplies | 4500 San Pablo Road, Jacksonville, FL 32224-1865 | 2005-09-29 |
| 1871054106 | Mayo Clinic Jacksonville | Clinic/Center | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2019-03-28 |
| 1558350413 | Mayo Clinic Jacksonville | Pharmacy | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-10-13 |
| 1962499079 | Mayo Clinic Jacksonville | Clinic/Center | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-10-04 |
| 1285621631 | Mayo Clinic Jacksonville | Clinical Medical Laboratory | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-09-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MAYO CLINIC JACKSONVILLE (A NONPROFIT CORPORATION) | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 |
| Street Address |
4500 SAN PABLO RD S |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32224-1865 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891799136 | Richard Clarke Agnew | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-06-01 |
| 1427657964 | Brianna Iannarelli | Nurse Anesthetist, Certified Registered | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-24 |
| 1538768981 | Heather Anne Dahlen | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-17 |
| 1578161717 | Szilvia Fortner | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-10 |
| 1265049464 | Carolyn Gonzalez | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-09-30 |
| 1467065748 | Ifeloluwa A Olutola | Family Medicine | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-26 |
| 1366055568 | Krina Dipak Vyas | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-26 |
| 1356954911 | Haleigh Diane Shelton | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-24 |
| 1215548805 | Victoria Zeilinger Reams | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-16 |
| 1558971382 | Rachel Marie Hannon | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356974372 | Noelle Parker | Specialist/Technologist | 1 Unf Drivve, Jacksonville, FL 32224 | 2020-02-18 |
| 1124685102 | Charcy Rene Stiller | Specialist/Technologist | 1 Unf Dr., Jacksonville, FL 32224 | 2019-05-24 |
| 1265097513 | Mayo Clinic Jacksonville | Ambulance | 13970 Zumbro Dr, Jacksonville, FL 32224 | 2019-05-02 |
| 1639681471 | Brigantti Anesthesia & Spine Care | Clinic/Center | 1361 13th Ave South Suite #210, Jacksonville, FL 32224 | 2017-11-02 |
| 1093240061 | Beric Emilio Berlioz | Anesthesiology | 4500 San Pablo Rd S # J, Jacksonville, FL 32224 | 2017-04-26 |
| 1609240746 | Matthew James Dailey | Nurse Anesthetist, Certified Registered | 2500 San Pablo Rd S, Jacksonville, FL 32224 | 2015-11-29 |
| 1003299603 | Upscale Personal Care Home | Assisted Living Facility | 4375 Autumn River Road, Jacksonville, FL 32224 | 2015-07-01 |
| 1629459375 | Bellanid Fonseca | Social Worker | 3694 Summerlin Ln E, Jacksonville, FL 32224 | 2015-06-17 |
| 1164840500 | Nicholas Scotto | Physical Therapist | 11555 Central Pkwy Ste 1104, Jacksonville, FL 32224 | 2014-04-02 |
| 1497093454 | Quicker Care Urgent Care | Point of Service | 13770 Beach Blvd., Unit # 4, Jacksonville, FL 32224 | 2013-01-27 |
| Find all providers in zip 32224 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285231548 | American Current Care P.a. | Clinic/Center | 1524 Normandy Village Pkwy, Jacksonville, FL 32221-3222 | 2020-10-08 |
| 1053879437 | Healthletix Management, LLC | Clinic/Center | 3948 Sunbeam Rd Ste 7, Jacksonville, FL 32257-8931 | 2019-03-05 |
| 1972010346 | Path Medical, LLC | Clinic/Center | 9119 Merrill Rd Ste 32, Jacksonville, FL 32225-4306 | 2018-01-06 |
| 1730580366 | Inception Healthcare Solutions LLC | Clinic/Center | 14701 Bartram Park Blvd Unit 1118, Jacksonville, FL 32258-5296 | 2014-09-15 |
| 1407277171 | Csi-pediatric Services, Inc. | Clinic/Center | 10750 Atlantic Blvd, Suite 11, Jacksonville, FL 32225-2946 | 2013-12-26 |
| 1831454248 | Holy Trinity Community Medical Center | Clinic/Center | 4001 Confederate Point Rd, Suite # 2, Jacksonville, FL 32210-5459 | 2012-07-11 |
| 1194057836 | Usimc of West Virginia Medical Corp | Clinic/Center | 7500 Centurion Pkwy Ste 100, Jacksonville, FL 32256-0517 | 2010-02-05 |
| 1437345014 | Occupational Health Centers of The Southwest, P.a. | Clinic/Center | 1584 Normandy Village Pkwy, Suite 32, Jacksonville, FL 32221-6800 | 2007-09-18 |
| 1508463845 | Concentra Medical Centers | Clinic/Center | 1524 Normandy Village Pkwy, Jacksonville, FL 32221-3222 | 2020-10-08 |
| 1679002364 | Occuaptional Health Centers of The Southwest, P.a. | Clinic/Center | 4933 University Blvd W, Jacksonville, FL 32216-5935 | 2017-06-07 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32224 |
Please comment or provide details below to improve the information on MAYO CLINIC JACKSONVILLE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.