Healthcare Provider Details

I. General information

NPI: 1689817405
Provider Name (Legal Business Name): BAPTIST PULMONARY SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 PRUDENTIAL DR STE 320
JACKSONVILLE FL
32207-8197
US

IV. Provider business mailing address

PO BOX 2462
SALT LAKE CITY UT
84110-2462
US

V. Phone/Fax

Practice location:
  • Phone: 904-376-3707
  • Fax: 904-391-5001
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE HOLLOWAY
Title or Position: DIRECTOR
Credential:
Phone: 904-202-5378