Provider Demographics
NPI:1245983568
Name:VOLUNTEERS IN MEDICINE JACKSONVILLE, INC
Entity type:Organization
Organization Name:VOLUNTEERS IN MEDICINE JACKSONVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-399-2766
Mailing Address - Street 1:41 EAST DUVAL STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202
Mailing Address - Country:US
Mailing Address - Phone:904-399-2766
Mailing Address - Fax:904-549-8300
Practice Address - Street 1:41 EAST DUVAL STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202
Practice Address - Country:US
Practice Address - Phone:904-399-2766
Practice Address - Fax:904-549-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty