MEDICARE: BAPTIST CARDIOLOGY 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	207RC0000X	Cardiovascular Disease Physician	605342	FL

General Provider Information

NPI Number	:	1629416805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST CARDIOLOGY INC

Provider Business Mailing Address
First Line	:	1905 CORPORATE SQUARE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1940
Country	:	US
Telephone Number	:	904-720-0799
Fax Number	:	904-720-5225

Provider Business Practice Location Address
First Line	:	1747 BAPTIST CLAY RD
Second Line	:	SUITE 320
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8501
Country	:	US
Telephone Number	:	904-224-5185
Fax Number	:	904-278-7284

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK MASTERS
Credential	:	PHD
Telephone Number	:	904-720-0799

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	06/10/2013

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