NPIMap

Organization Active NPI

Baptist Agewell Physicians Inc

  • Geriatric Medicine (Internal Medicine) Physician
  • Jacksonville Beach, FL
National Provider Identifier
1710464946
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
BAPTIST AGEWELL PHYSICIANS INC
Practice address
1350 13TH Ave S Ste 118-a
Jacksonville Beach, FL 32250-3203
Phone
(904) 202-4600
Fax
(904) 202-4639
NPI assigned
Jul 20, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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

Authorized official

Name
Marsha Donaldson
Title
Vice President
Phone
(904) 376-3703

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X FL Primary

Addresses

Primary practice location

1350 13TH Ave S Ste 118-a
Jacksonville Beach, FL 32250-3203

Mailing address

PO Box 3162
Salt Lake City, UT 84110-3162
Phone (904) 202-1032

National Provider Directory

National Provider Directory
Tax ID family
Baptist Agewell Physicians Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1350 13th Ave S
Ste 118A
Jacksonville Beach, FL 32250
Phone (904) 202-4600

NPI Registry JSON

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

{
    "created_epoch": "1532044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544572800000",
    "number": "1710464946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3162",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841103162",
            "telephone_number": "904-202-1032",
            "fax_number": "904-373-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 13TH AVE S STE 118-A",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503203",
            "telephone_number": "904-202-4600",
            "fax_number": "904-202-4639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST AGEWELL PHYSICIANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-20",
        "last_updated": "2018-12-12",
        "status": "A",
        "authorized_official_last_name": "DONALDSON",
        "authorized_official_first_name": "MARSHA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "904-376-3703"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; 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.