1750159604 NPI number — SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC

Table of content: (NPI 1750159604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750159604 NPI number — SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN BAPTIST HOSPITAL OF FLORIDA, 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:
1750159604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 746630
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-6630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-376-4149
Provider Business Mailing Address Fax Number:
904-618-2159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
461 OUTLET MALL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32084-2493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-376-4149
Provider Business Practice Location Address Fax Number:
904-618-2159
Provider Enumeration Date:
12/19/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BOYCE
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CHIEF REVENUE OFFICER
Authorized Official Telephone Number:
904-376-3760

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com