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General NPI Number Information
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NPI Number | 1972044857
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Entity Type | Organization
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Legal Business Name | SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 800 PRUDENTIAL DRIVE LABORATORY
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City | JACKSONVILLE
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State | FL
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Zip | 32207
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Country | US
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Telephone | 904-202-2006
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Fax | 904-346-0235
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Provider Business Mailing Address
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Address Line | 800 PRUDENTIAL DRIVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207
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Country | US
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Telephone | 904-202-2016
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Fax | 904-346-0235
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. A. HUGH GREENE
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Credential |
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Telephone | 904-202-4011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 800000149
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License Number State | FL
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