Baptist Primary Care - Internal Medical Group Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BAPTIST PRIMARY CARE - INTERNAL MEDICAL GROUP INC

Practice address

820 Prudential Dr
Suite 314
Jacksonville, FL 32207-8210

Phone

(904) 396-2223

NPI assigned

Jul 21, 2011

Last updated

Jul 21, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Earl B Mally

Title

Sr. Vice President

Phone

(904) 376-4275

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311206400000",
    "number": "1144508375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 BAYMEADOWS WAY",
            "address_2": "SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322568234",
            "telephone_number": "904-396-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 PRUDENTIAL DR",
            "address_2": "SUITE 314",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078210",
            "telephone_number": "904-396-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST PRIMARY CARE - INTERNAL MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-21",
        "last_updated": "2011-07-21",
        "status": "A",
        "authorized_official_last_name": "MALLY",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT",
        "authorized_official_telephone_number": "904-376-4275"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; 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.