Basic Information
| Provider Information | |||||||||
| NPI: | 1376803155 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST CARDIOLOGY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAPTIST HEART SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1905 CORPORATE SQUARE BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322161940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047200799 | ||||||||
| FaxNumber: | 9047205225 | ||||||||
| Practice Location | |||||||||
| Address1: | 6930 BONNEVAL RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322166084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048546899 | ||||||||
| FaxNumber: | 9043380533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2012 | ||||||||
| LastUpdateDate: | 05/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | MASTERS | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9047200799 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173F00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Sleep Specialist, PhD |
No ID Information.