1457624447 NPI number — BAPTIST CARDIOLOGY, INC.

Table of content: (NPI 1457624447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457624447 NPI number — BAPTIST CARDIOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST CARDIOLOGY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457624447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 43667
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32203-3667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-224-5189
Provider Business Mailing Address Fax Number:
904-725-1622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11236 BAPTIST HEALTH DR STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32218-2989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-224-9303
Provider Business Practice Location Address Fax Number:
904-764-0086
Provider Enumeration Date:
02/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MASTERS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
904-425-4557

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004946600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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