Active NPI
Lyerly Baptist Inc
- Neurology Physician
- Jacksonville, FL
National Provider Identifier
1821313883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- ME81147
- Legal business name
- LYERLY BAPTIST INC
- Practice address
- 14546 Old Saint Augustine Rd
Suite 301
Jacksonville, FL 32258-5468 - Phone
- (904) 292-4049
- Fax
- (904) 292-4805
- NPI assigned
- Apr 2, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Earl B Mally
- Title
- Senior Vice President
- Phone
- (904) 376-4275
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | ME81147 | FL | Primary |
Addresses
Primary practice location
14546 Old Saint Augustine Rd
Suite 301
Jacksonville, FL 32258-5468
Mailing address
14546 Old Saint Augustine Rd
Suite 301
Jacksonville, FL 32258-5468
Phone (904) 292-4049
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
836 Prudential Dr
Ste 1400
Jacksonville, FL 32207
Phone (904) 396-0000
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Vascular Neurology Physician
- Jacksonville, FL
- NPI 1558504423
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270166400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1270166400000",
"number": "1821313883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14546 OLD SAINT AUGUSTINE RD",
"address_2": "SUITE 301",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322585468",
"telephone_number": "904-292-4049",
"fax_number": "904-292-4805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14546 OLD SAINT AUGUSTINE RD",
"address_2": "SUITE 301",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322585468",
"telephone_number": "904-292-4049",
"fax_number": "904-292-4805"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LYERLY BAPTIST INC",
"organizational_subpart": "NO",
"enumeration_date": "2010-04-02",
"last_updated": "2010-04-02",
"status": "A",
"authorized_official_last_name": "MALLY",
"authorized_official_first_name": "EARL",
"authorized_official_middle_name": "B",
"authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
"authorized_official_telephone_number": "904-376-4275"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Neurology",
"state": "FL",
"license": "ME81147",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.