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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1588285126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST NEUROLOGY INC

Provider Business Mailing Address
First Line	:	PO BOX 41113
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-1113
Country	:	US
Telephone Number	:	904-376-4400
Fax Number	:	904-391-5595

Provider Business Practice Location Address
First Line	:	7807 BAYMEADOWS RD E STE 401
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9668
Country	:	US
Telephone Number	:	904-730-3689
Fax Number	:	904-730-3688

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JASON R KIMBALL
Credential	:
Telephone Number	:	904-202-6295

Provider Enumeration Date	:	05/06/2020
Last Update Date	:	05/06/2020

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