904 HEALTH, INC
Complete NPI Record 1699487678
Clinic/Center - Primary Care in Yulee, FL
Active since December 21, 2022
Complete NPI Dataset
This page contains the complete raw NPPES record for 904 Health, Inc (NPI 1699487678), a clinic/center organization in Yulee, FL. All 37 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
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Registry File Document Utilities
- NPI: 1699487678 Field 1/37
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/37
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/37
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: 904 HEALTH, INC Field 4/37
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/37
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/37
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 221 N HOGAN ST STE 118 Field 7/37
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: JACKSONVILLE Field 8/37
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: FL Field 9/37
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 322024201 Field 10/37
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/37
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 9046592475 Field 12/37
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 9044538600 Field 13/37
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 96040 LOFTON SQUARE CT Field 14/37
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: YULEE Field 15/37
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: FL Field 16/37
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 320976347 Field 17/37
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/37
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 9046592475 Field 19/37
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 9044538600 Field 20/37
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: KELLY Field 23/37
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: WENDY Field 24/37
- The first name of the authorized official.
- Authorized Official Title or Position: OFFICE ADMINISTRATOR Field 25/37
- The title or position of the authorized official.
- Authorized Official Telephone Number: 5636502158 Field 26/37
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207RI0200X Field 27/37
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 28/37
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 251K00000X Field 29/37
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 30/37
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 261QH0100X Field 31/37
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: N Field 32/37
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 4: 261QP2300X Field 33/37
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 4: Y Field 34/37
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 35/37
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP Field 36/37
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
Manager Other Name
Name 1/1Other Name: Any additional name associated with either an individual provider or an organization that does not fall under the other defined name type categories.
Secondary Practice Locations 11
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
2420 S Highway 29
Location 1/11Cantonment, FL 32533-5808 · Phone (904) 900-1513 · Fax (904) 575-4944
3574 US 1 S Ste 101-104
Location 2/11St Augustine, FL 32086-6466 · Phone (904) 900-1513 · Fax (904) 575-4944
1241 Blanding Blvd Ste 5
Location 3/11Orange Park, FL 32065-5908 · Phone (904) 900-1513 · Fax (904) 575-4944
4427 Emerson St Ste A
Location 4/11Jacksonville, FL 32207-4969 · Phone (904) 900-1513 · Fax (904) 575-4944
320 Oakfield Dr
Location 5/11Brandon, FL 33511-5723 · Phone (904) 900-1513 · Fax (904) 575-4944
1104 E Fowler Ave Unit 100
Location 6/11Tampa, FL 33612-5404 · Phone (904) 900-1513 · Fax (904) 575-4944
7207 N Nebraska Ave
Location 7/11Tampa, FL 33604-4916 · Phone (904) 904-1513 · Fax (904) 575-4944
5951 Clark Center Ave Unit B
Location 8/11Sarasota, FL 34238-2717 · Phone (904) 900-1513 · Fax (904) 575-4944
2102 14th St W
Location 9/11Bradenton, FL 34205-6351 · Phone (904) 900-1513 · Fax (904) 575-4944
1823 Business Park Blvd
Location 10/11Daytona Beach, FL 32114-1230 · Phone (904) 900-1513 · Fax (904) 575-4944
57 Town Ct Ste 215
Location 11/11Palm Coast, FL 32164-2425 · Phone (904) 900-1513 · Fax (904) 575-4944
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