Concentra Medical Center-Jax Northside
Clinic/Center, Health Services in Jacksonville, FL. Organization (NPI-2).
Details
- NPI
- 1629264288
- Entity type
- Organization (NPI-2)
- Legal business name
- Concentra Medical Center-Jax Northside
- Organization subpart
- No
- Enumeration date
- Sep 18, 2007
- Last updated
- Sep 18, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QH0100X | Clinic/Center, Health Services | – | – | Yes |
Practice location
1215 Dunn AveSte. 7
Jacksonville, FL 32218-6330
Phone 904-757-5656 · Fax 904-757-5650
Mailing address
5080 Spectrum DrSte. 1200 West Tower
Addison, TX 75001-4648
Phone 800-232-3550 · Fax 800-401-6728
Authorized official
Tom Fogarty
Evp, Cmo
8002323550
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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