Healthcare Provider Details

I. General information

NPI: 1457624447
Provider Name (Legal Business Name): BAPTIST CARDIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11236 BAPTIST HEALTH DR STE 310
JACKSONVILLE FL
32218-2989
US

IV. Provider business mailing address

PO BOX 43667
JACKSONVILLE FL
32203-3667
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-9303
  • Fax: 904-764-0086
Mailing address:
  • Phone: 904-224-5189
  • Fax: 904-725-1622

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: 904-425-4557