Children's Medical Center | |
6704 E Mount Vernon St Glen St Mary FL 32040-5050 | |
(904) 259-7420 | |
(904) 259-8366 |
Full Name | Children's Medical Center |
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Speciality | Clinic/Center |
Location | 6704 E Mount Vernon St, Glen St Mary, Florida |
Authorized Official Name and Position | Andres R Villar (ADMINISTRATOR) |
Authorized Official Contact | 3867555044 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Children's Medical Center Po Box 606 Glen St Mary FL 32040-0606 Ph: (904) 653-1818 | Children's Medical Center 6704 E Mount Vernon St Glen St Mary FL 32040-5050 Ph: (904) 259-7420 |
NPI Number | 1629162722 |
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Provider Enumeration Date | 10/03/2006 |
Last Update Date | 07/22/2021 |
Medicare PECOS PAC ID | 5092623439 |
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Medicare Enrollment ID | O20041008000325 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629162722 | NPI | - | NPPES |
660151100 | Other | FL | MEDICAID RURAL HEALTH CLINIC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |