Provider Demographics
NPI:1184305435
Name:904 HEALTH, INC
Entity type:Organization
Organization Name:904 HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TARVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-403-2079
Mailing Address - Street 1:221 N HOGAN ST STE 118
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4201
Mailing Address - Country:US
Mailing Address - Phone:904-900-1513
Mailing Address - Fax:904-575-4944
Practice Address - Street 1:4427 EMERSON ST STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4969
Practice Address - Country:US
Practice Address - Phone:904-659-2475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:904 HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-28
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care