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NPI Code Detail

MEDICARE: BAPTIST OCCUPATIONAL HEALTH, INC.

MEDICARE: BAPTIST OCCUPATIONAL HEALTH, 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
1261QU0200XUrgent Care Clinic/CenterFL

General Provider Information

NPI Number : 1255462123
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAPTIST OCCUPATIONAL HEALTH, INC.
Provider Business Mailing Address
First Line : 3563 PHILLIPS HWY
Second Line : SUITE 106
City : JACKSONVILLE
State : FL
Zip : 32207-5663
Country : US
Telephone Number : 904-202-5304
Fax Number : 904-202-5587
Provider Business Practice Location Address
First Line : 5978 POWERS AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-2210
Country : US
Telephone Number : 904-737-8686
Fax Number : 904-448-5414
Authorized Official
Title or Position : SR VICE PRESIDENT
Name : EARL B MALLY
Credential :
Telephone Number : 904-376-4275
Provider Enumeration Date : 03/09/2007
Last Update Date : 11/25/2009

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