Healthcare Provider Details

I. General information

NPI: 1255462123
Provider Name (Legal Business Name): BAPTIST OCCUPATIONAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5978 POWERS AVE
JACKSONVILLE FL
32217-2210
US

IV. Provider business mailing address

3563 PHILLIPS HWY SUITE 106
JACKSONVILLE FL
32207-5663
US

V. Phone/Fax

Practice location:
  • Phone: 904-737-8686
  • Fax: 904-448-5414
Mailing address:
  • Phone: 904-202-5304
  • Fax: 904-202-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: EARL B MALLY
Title or Position: SR VICE PRESIDENT
Credential:
Phone: 904-376-4275