Provider Demographics
NPI:1912219064
Name:EMED URGENT AND PRIMARY CARE INC
Entity Type:Organization
Organization Name:EMED URGENT AND PRIMARY CARE INC
Other - Org Name:EMED MULTISPECIALTY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:U
Authorized Official - Last Name:PULIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-513-3240
Mailing Address - Street 1:2624 ATLANTIC BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207
Mailing Address - Country:US
Mailing Address - Phone:904-513-3240
Mailing Address - Fax:904-379-2911
Practice Address - Street 1:2624 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3609
Practice Address - Country:US
Practice Address - Phone:904-513-3240
Practice Address - Fax:904-379-2911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMED URGENT AND PRIMARY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-06
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207RP1001X, 208VP0000X, 208VP0014X, 332B00000X, 363LP0200X, 363LW0102X, 363LW0102X
FL10D2009297291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002464700Medicaid
FL9818064OtherCIGNA
FL148KPOtherBLUE CROSS BLUE SHEILD
FL004248300Medicaid
FL338970OtherAVMED