Provider Demographics
NPI:1972044857
Name:SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC
Entity type:Organization
Organization Name:SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:A. HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-202-4011
Mailing Address - Street 1:800 PRUDENTIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207
Mailing Address - Country:US
Mailing Address - Phone:904-202-2016
Mailing Address - Fax:904-346-0235
Practice Address - Street 1:800 PRUDENTIAL DRIVE
Practice Address - Street 2:LABORATORY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-202-2006
Practice Address - Fax:904-346-0235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800000149291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100641-00Medicaid
FL100641-00Medicaid