Provider Demographics
NPI:1720417884
Name:AMELIA URGENT CARE LLC
Entity Type:Organization
Organization Name:AMELIA URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATRICIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-583-3016
Mailing Address - Street 1:510 AIRPORT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7260
Mailing Address - Country:US
Mailing Address - Phone:904-696-0055
Mailing Address - Fax:904-551-6533
Practice Address - Street 1:96279 BRADY POINT RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-7076
Practice Address - Country:US
Practice Address - Phone:904-321-1177
Practice Address - Fax:904-321-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6933261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA555Medicare UPIN