Provider Demographics
NPI:1477625515
Name:ST JOHNS EXPRESS CARE PA
Entity Type:Organization
Organization Name:ST JOHNS EXPRESS CARE PA
Other - Org Name:WALK IN MEDICAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BUDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-280-1300
Mailing Address - Street 1:880 A1A NORTH
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082
Mailing Address - Country:US
Mailing Address - Phone:904-280-1300
Mailing Address - Fax:904-280-1220
Practice Address - Street 1:880 A1A NORTH
Practice Address - Street 2:SUITE 16
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082
Practice Address - Country:US
Practice Address - Phone:904-280-1300
Practice Address - Fax:904-280-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044413207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D61843Medicare UPIN
FL15960Medicare ID - Type Unspecified