Provider Demographics
NPI:1457690471
Name:ST. VINCENT'S MEDICAL CENTER-CLAY COUNTY, INC.
Entity Type:Organization
Organization Name:ST. VINCENT'S MEDICAL CENTER-CLAY COUNTY, INC.
Other - Org Name:ASCENSION ST. VINCENT'S CLAY COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOODY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-308-8446
Mailing Address - Street 1:4205 BELFORT ROAD
Mailing Address - Street 2:JAB # 4020
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-450-6020
Mailing Address - Fax:
Practice Address - Street 1:1670 ST VINCENTS WAY
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8447
Practice Address - Country:US
Practice Address - Phone:904-308-8446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital