ST LUKES - ST VINCENTS HEALTHCARE (NPI# 1396926747) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396926747 |
| Entity Type | Organization |
| Organization Name | ST LUKES - ST VINCENTS HEALTHCARE |
| Other Organization Name | ASCENSION ST. VINCENT'S SOUTHSIDE |
| Practice Address |
4201 Belfort Rd Jacksonville FL 32216-1431 |
| Mailing Address |
4205 Belfort Rd Jab # 4020 Jacksonville FL 32216 |
| Practice Telephone | 9042963700 |
| Mailing Telephone | 9044506020 |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2019-03-15 |
| Authorized Official Name | JEREMY DEAN KRAFT (DIRECTOR- NET REVENUE) |
| Authorized Official Telephone | 9044506020 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | Hospitals |
| Other Name | Type Code |
|---|---|
| Ascension St. Vincent's Southside | Doing Business As Name - Organization |
| St Vincents Medical Center Southside | Doing Business As Name - Organization |
| Street Address |
4201 BELFORT RD |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32216-1431 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205823267 | Michael Gordon Maxwell | Emergency Medicine | 4201 Belfort Rd, Jacksonville, FL 32216-1431 | 2005-10-04 |
| 1285247411 | Victoria Potts | Anesthesiologist Assistant | 4201 Belfort Rd, Jacksonville, FL 32216-1431 | 2020-08-27 |
| 1003442005 | Yu-chun Li | Nurse Practitioner | 4201 Belfort Rd, Jacksonville, FL 32216-1431 | 2020-03-21 |
| 1265963680 | Tanner Miles | Emergency Medicine | 4201 Belfort Rd, Jacksonville, FL 32216-1431 | 2017-03-27 |
| 1437522638 | Shela Towanna Mainor | Physician Assistant | 4201 Belfort Rd, St. Vincent's Medical Center Southside, Jacksonville, FL 32216-1431 | 2015-11-10 |
| 1275914269 | Neonila Zhukivskyy | Internal Medicine | 4201 Belfort Rd, Jacksonville, FL 32216-1431 | 2015-06-15 |
| 1689063406 | Elite Hospitalist Group | Internal Medicine | 4201 Belfort Rd, Jacksonville, FL 32216-1431 | 2015-01-16 |
| 1689929903 | Lorilee Olmoguez | Pharmacist | 4201 Belfort Rd, Jacksonville, FL 32216-1431 | 2012-07-24 |
| 1518212547 | Happy Farouk Sadiek | Internal Medicine | 4201 Belfort Rd, Jacksonville, FL 32216-1431 | 2012-07-16 |
| 1285991802 | Kimberlie Stickney | Physician Assistant | 4201 Belfort Rd, Jacksonville, FL 32216-1431 | 2012-04-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524925 | Renee Cherie Titus | Behavior Technician | Growing Together Center 6789 Southpoint Parkway, Building 100, Jacksonville, FL 32216 | 2020-09-24 |
| 1811546575 | First Coast Orthopedic Center, LLC | Clinic/Center | 4035 Southpoint Boulevard, Jacksonville, FL 32216 | 2019-09-05 |
| 1922578558 | Fatima Hussain Crofton | Optometrist | 7051 Southpoint Parkway S 300, Jacksonville, FL 32216 | 2018-11-27 |
| 1154802833 | John-paul Pham | Internal Medicine | 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 | 2018-08-22 |
| 1790279479 | Joseph Richard Kennedy | Physician Assistant | 6650 Corporate Center Pkwy Apt 1604, Jacksonville, FL 32216 | 2018-06-18 |
| 1801304357 | Kelli M. Tyson | Nurse Practitioner | 3550 University Blvd. S., Ste 302, Jacksonville, FL 32216 | 2018-01-18 |
| 1376054809 | Angela M Whittinghill | Counselor | 8833 Perimeter Park Blvd #702, Jacksonville, FL 32216 | 2017-10-24 |
| 1629508072 | Zoryana Yufan | Dentist | 8750 Perimeter Park Blvd Ste 101, Jacksonville, FL 32216 | 2017-06-19 |
| 1700318896 | Christina Kaczmarek | Behavior Technician | 6816 Southpoint Pkwy Ste 500, Jacksonville, FL 32216 | 2017-03-29 |
| 1932640422 | Loudine Racius | Nurse Practitioner | 8539 Gate Parkway W, Unit 1422, Jacksonville, FL 32216 | 2017-03-16 |
| Find all providers in zip 32216 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528683257 | Gainesville Vamc | General Acute Care Hospital | 2080 Child St Bldg 200h, Jacksonville, FL 32214-5005 | 2020-06-09 |
| 1922487974 | Shemaka James | General Acute Care Hospital | 5202 Wabash Blvd, Jacksonville, FL 32254-1366 | 2015-05-22 |
| 1962893149 | Michelle Porter | General Acute Care Hospital | 402 Stagecoach Dr, Jacksonville, NC 28546-8663 | 2015-02-10 |
| 1811246390 | St. Vincent's Healthcare | General Acute Care Hospital | 3 Shircliff Way Ste 714, Jacksonville, FL 32204-4786 | 2012-08-30 |
| 1255570974 | Svila Skin Solutions | General Acute Care Hospital | 1936 San Marco Blvd, Jacksonville, FL 32207-3286 | 2009-02-19 |
| 1760644009 | Walter Ruday Jr. | General Acute Care Hospital | 2748 University Blvd W, Jacksonville, FL 32217-2123 | 2008-06-27 |
| 1386801116 | Abdolreza Mohammadian | General Acute Care Hospital | 1536 N.jefferson Street, Va Outpatient Clinic, Jacksonville, FL 32209-0000 | 2008-05-20 |
| 1861451114 | Allegiance Hospital of North Little Rock, LLC | General Acute Care Hospital | 1400 Braden St., Jacksonville, AR 72076 | 2006-03-23 |
| 1730697350 | Jacksonville Hospital LLC | General Acute Care Hospital | 501 S Ragsdale St, Jacksonville, TX 75766-2434 | 2018-01-17 |
| 1144735069 | Brynn Marr Hospital - Navy Resource Sharing | General Acute Care Hospital | 192 Village Dr, Jacksonville, NC 28546-7238 | 2017-12-14 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32216 |
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| 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.