Provider Demographics
NPI:1790743854
Name:BAPTIST CARDIOLOGY, INC.
Entity Type:Organization
Organization Name:BAPTIST CARDIOLOGY, INC.
Other - Org Name:BAPTIST HEART SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-720-0799
Mailing Address - Street 1:1905 CORPORATE SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1940
Mailing Address - Country:US
Mailing Address - Phone:904-720-0799
Mailing Address - Fax:904-720-5225
Practice Address - Street 1:1905 CORPORATE SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1940
Practice Address - Country:US
Practice Address - Phone:904-720-0599
Practice Address - Fax:904-720-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374770100Medicaid
FLCC1812Medicare PIN
FL24485Medicare PIN
FL374770100Medicaid