MEDICARE: BAPTIST NEUROLOGY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1083019772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST NEUROLOGY INC

Provider Business Mailing Address
First Line	:	PO BOX 40767
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-0767
Country	:	US
Telephone Number	:	904-376-3740
Fax Number	:	904-391-5807

Provider Business Practice Location Address
First Line	:	1747 BAPTIST CLAY DR, SUITE 310
Second Line	:	ATTN: CREDENTIALING DEPARTMENT
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8502
Country	:	US
Telephone Number	:	904-224-8090
Fax Number	:	904-224-8097

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	STANLEY BROOKS
Credential	:
Telephone Number	:	904-202-5558

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	01/26/2015

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Directions to “BAPTIST NEUROLOGY INC ” Practice Location

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