MEDICARE: BAPTIST CARDIOLOGY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	000000000000000	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578805875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST CARDIOLOGY INC

Provider Business Mailing Address
First Line	:	1905 CORPORATE SQUARE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1940
Country	:	US
Telephone Number	:	904-720-0799
Fax Number	:	904-720-5225

Provider Business Practice Location Address
First Line	:	1747 BAPTIST CLAY RD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32003-8501
Country	:	US
Telephone Number	:	904-000-0000
Fax Number	:	904-000-0000

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARK A MASTERS
Credential	:	PHD
Telephone Number	:	904-720-0799

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	03/25/2013

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Directions to “BAPTIST CARDIOLOGY INC ” Practice Location

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