Provider Demographics
NPI:1821155912
Name:BAPTIST MEDICAL CENTER OF THE BEACHES, INC
Entity Type:Organization
Organization Name:BAPTIST MEDICAL CENTER OF THE BEACHES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-376-3760
Mailing Address - Street 1:P O BOX 45058
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32232-5058
Mailing Address - Country:US
Mailing Address - Phone:904-376-4182
Mailing Address - Fax:904-376-4280
Practice Address - Street 1:1350 13TH AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3203
Practice Address - Country:US
Practice Address - Phone:904-376-4182
Practice Address - Fax:904-376-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4304282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL128OtherBLUE CROSS PROVIDER NUMBE
FL010232600Medicaid
GA00150345AOtherMEDICAID OF GA PROVIDER
FL128OtherBLUE CROSS PROVIDER NUMBE