Healthcare Provider Details

I. General information

NPI: 1316112014
Provider Name (Legal Business Name): SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

PO BOX 45094
JACKSONVILLE FL
32232-5094
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2092
  • Fax: 904-376-4280
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number4448
License Number StateFL

VIII. Authorized Official

Name: PHILIP BOYCE
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 904-376-3760