Provider Demographics
NPI:1518266626
Name:VETERANS HEALTH CARE SYSTEMS NORTH FLORIDA
Entity Type:Organization
Organization Name:VETERANS HEALTH CARE SYSTEMS NORTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIT WORK LEADER/MEDICAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:KELVIN
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:904-866-6914
Mailing Address - Street 1:1015 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-2073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-2073
Practice Address - Country:US
Practice Address - Phone:904-866-6914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5281286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital