NPIMap

Organization Active NPI

Baptist MD Anderson Cancer Physicians Inc

Doing business as Baptist MD Anderson Cancer Physicians

  • Gynecologic Oncology Physician
  • Jacksonville, FL
National Provider Identifier
1083153365
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
Legal business name
BAPTIST MD ANDERSON CANCER PHYSICIANS INC
Doing business as
Baptist MD Anderson Cancer Physicians
Practice address
14540 Old Saint Augustine Rd
Suite 2593
Jacksonville, FL 32258-7418
Phone
(904) 389-3993
Fax
(904) 389-3994
NPI assigned
Feb 20, 2017
Last updated
Apr 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leeann Mengel
Title
Administrator
Phone
(904) 202-7300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician 207VX0201X FL Primary

Addresses

Primary practice location

14540 Old Saint Augustine Rd
Suite 2593
Jacksonville, FL 32258-7418

Mailing address

PO Box 746654
Atlanta, GA 30374-6654
Phone (904) 202-2092

Other identifiers 2

IdentifierTypeStateIssuer
DU3570OtherFLRR MEDICARE
009942200MedicaidFL

Other names 1

  • Baptist MD Anderson Cancer Physicians Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Baptist MD Anderson Cancer Physicians Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14540 Old St Augustine Rd
Ste 2593
Jacksonville, FL 32258
Phone (904) 328-5289

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1083153365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746654",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746654",
            "telephone_number": "904-202-2092",
            "fax_number": "904-393-7603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14540 OLD SAINT AUGUSTINE RD",
            "address_2": "SUITE 2593",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322587418",
            "telephone_number": "904-389-3993",
            "fax_number": "904-389-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST MD ANDERSON CANCER PHYSICIANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-20",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "MENGEL",
        "authorized_official_first_name": "LEEANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-202-7300"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DU3570",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009942200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist MD Anderson Cancer Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.