Healthcare Provider Details

I. General information

NPI: 1235403221
Provider Name (Legal Business Name): BAPTIST CARDIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11513 N MAIN ST
JACKSONVILLE FL
32218-4002
US

IV. Provider business mailing address

3563 PHILLIPS HWY SUITE 101
JACKSONVILLE FL
32207-5663
US

V. Phone/Fax

Practice location:
  • Phone: 904-720-0799
  • Fax: 904-720-5225
Mailing address:
  • Phone: 904-720-0799
  • Fax: 904-720-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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