Healthcare Provider Details

I. General information

NPI: 1881937993
Provider Name (Legal Business Name): BAPTIST CARDIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 BAPTIST CLAY DRIVE SUITE 310
FLEMING ISLAND FL
32003-8501
US

IV. Provider business mailing address

1771 BAPTIST CLAY DRIVE SUITE 310
FLEMING ISLAND FL
32003-8501
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-0998
  • Fax: 904-398-8481
Mailing address:
  • Phone: 904-398-0998
  • Fax: 904-398-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number000000000000000
License Number StateFL

VIII. Authorized Official

Name: MARK A MASTERS
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 904-720-0799