Healthcare Provider Details

I. General information

NPI: 1417521725
Provider Name (Legal Business Name): BAPTIST SPECIALTY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8705 PERIMETER PARK BLVD STE 8
JACKSONVILLE FL
32216-6353
US

IV. Provider business mailing address

PO BOX 44047
JACKSONVILLE FL
32231-4047
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-7771
  • Fax: 904-296-7772
Mailing address:
  • Phone: 904-376-4083
  • Fax: 904-391-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: THABATA FORD
Title or Position: VICE PRESIDENT
Credential:
Phone: 904-391-5578