Healthcare Provider Details

I. General information

NPI: 1376803155
Provider Name (Legal Business Name): BAPTIST CARDIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 BONNEVAL RD
JACKSONVILLE FL
32216-6084
US

IV. Provider business mailing address

1905 CORPORATE SQUARE BLVD
JACKSONVILLE FL
32216-1940
US

V. Phone/Fax

Practice location:
  • Phone: 904-854-6899
  • Fax: 904-338-0533
Mailing address:
  • Phone: 904-720-0799
  • Fax: 904-720-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State

VIII. Authorized Official

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