MEDICARE: SOUTHERN BAPTIST HOSPITAL OF FLORIDA, 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	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174297626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC

Provider Business Mailing Address
First Line	:	PO BOX 45094
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32232-5094
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1771 BAPTIST CLAY DR
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8501
Country	:	US
Telephone Number	:	904-516-1000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF REVENUE OFFICER
Name	:	PHILIP BOYCE
Credential	:
Telephone Number	:	904-376-3760

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	06/02/2022

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