NPIMap

Organization Active NPI

Baptist ENT Specialists Inc

  • Otolaryngology Physician
  • Fernandina Beach, FL
National Provider Identifier
1114477940
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
BAPTIST ENT SPECIALISTS INC
Practice address
1348 S 18TH St
Suite 340
Fernandina Beach, FL 32034-4785
Phone
(904) 775-5957
Fax
(904) 844-2149
NPI assigned
Oct 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Authorized official

Name
Catherine Graham
Title
Administrator
Phone
(904) 202-5370

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X FL Primary

Addresses

Primary practice location

1348 S 18TH St
Suite 340
Fernandina Beach, FL 32034-4785

Mailing address

PO Box 41516
Jacksonville, FL 32203-1516
Phone (904) 202-5111

Other identifiers 2

IdentifierTypeStateIssuer
DS0498OtherFLRR MEDICARE
004630400MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Baptist ENT Specialists Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1475625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1114477940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41516",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322031516",
            "telephone_number": "904-202-5111",
            "fax_number": "904-391-5836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1348 S 18TH ST",
            "address_2": "SUITE 340",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320344785",
            "telephone_number": "904-775-5957",
            "fax_number": "904-844-2149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST ENT SPECIALISTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-05",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-202-5370"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DS0498",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004630400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fernandina Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.