Provider Demographics
NPI:1942515804
Name:30 MINUTE MEDICAL PRIMARY CARE
Entity Type:Organization
Organization Name:30 MINUTE MEDICAL PRIMARY CARE
Other - Org Name:30 MIN. MEDICAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIAGIO
Authorized Official - Middle Name:V
Authorized Official - Last Name:VULTAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-777-1650
Mailing Address - Street 1:8540 ARGYLE FOREST BLVD.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6314
Mailing Address - Country:US
Mailing Address - Phone:904-777-1650
Mailing Address - Fax:904-777-1665
Practice Address - Street 1:8540 ARGYLE FOREST BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6702
Practice Address - Country:US
Practice Address - Phone:904-777-1650
Practice Address - Fax:904-777-1665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:30 MIN. MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-16
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty