Baptist Primary Care Inc
Organization Active NPI Family Medicine Physician · Callahan, FL
NPI 1457532400 · NPPES record last updated Nov 25, 2020
Key facts
- NPI
- 1457532400
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- BAPTIST PRIMARY CARE INC
- Practice address
- 45465 5TH Ave
Callahan, FL 32011-3901 - Phone
- (904) 879-4544
- Fax
- (904) 879-4411
- NPI assigned
- Nov 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Marsha Donaldson
- Title
- Vice President
- Phone
- (904) 376-3703
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0726129 | Baptist Primary Care Callahan | Certificate of waiver | Jul 19, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031217000248 | FL | Part B Supplier - Clinic/Group Practice | 0648177733 |
Receives reassigned benefits from 567 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
45465 5TH Ave
Callahan, FL 32011-3901
Mailing address
PO Box 45443
Salt Lake City, UT 84145-0443
Phone (904) 202-1032
Other providers in Callahan, FL
- Kathryn Kelly Anderson
- Victoria Anderson
- Danielle Austin
- Juan Avelino
- Jaleesa Bachmann
- Lisa Blas
- Bloom Pediatrics, PLLC
- Mark Nicholas Brinkman
- Callahan Chiropractic Clinic
- Callahan Health Group Inc
All providers in Callahan, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.