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

General Provider Information

NPI Number	:	1790051845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST CARDIOLOGY, INC.

Provider Business Mailing Address
First Line	:	3563 PHILLIPS HWY
Second Line	:	SUITE 101
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5663
Country	:	US
Telephone Number	:	904-720-0799
Fax Number	:	904-720-5225

Provider Business Practice Location Address
First Line	:	14546 OLD SAINT AUGUSTINE RD
Second Line	:	SUITE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5468
Country	:	US
Telephone Number	:	904-338-0855
Fax Number	:	904-338-0852

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARK MASTERS
Credential	:	PHD
Telephone Number	:	904-720-0799

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	03/22/2012

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Directions to “BAPTIST CARDIOLOGY, INC. ” Practice Location

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