Provider Demographics
NPI:1407226228
Name:BAPTIST SPECIALTY PHYSICIANS INC
Entity Type:Organization
Organization Name:BAPTIST SPECIALTY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THABATA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATCHELOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-202-5048
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4047
Mailing Address - Country:US
Mailing Address - Phone:904-376-4083
Mailing Address - Fax:904-391-5075
Practice Address - Street 1:1660 PRUDENTIAL DR STE 320
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8197
Practice Address - Country:US
Practice Address - Phone:904-376-3707
Practice Address - Fax:904-391-5001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAVILION HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-06
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2080P0202X, 208G00000X
2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty