Active NPI
Lyerly Baptist Inc
- Neurology Physician
- Jacksonville, FL
National Provider Identifier
1962736413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- Legal business name
- LYERLY BAPTIST INC
- Practice address
- 2736 University Blvd W
Suite 3
Jacksonville, FL 32217-2179 - Phone
- (904) 733-4262
- Fax
- (904) 636-5786
- NPI assigned
- Sep 30, 2009
- Last updated
- Sep 30, 2009
- 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
- John Wilbanks
- Title
- Chief Operating Officer
- Phone
- (904) 376-4275
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | NU | Primary |
Addresses
Primary practice location
2736 University Blvd W
Suite 3
Jacksonville, FL 32217-2179
Mailing address
2736 University Blvd W
Suite 3
Jacksonville, FL 32217-2179
Phone (904) 733-4262
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060111001171 | FL | Part B Supplier - Clinic/Group Practice | 9830112226 |
Receives reassigned benefits from 77 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fernandina Beach, FL; Yulee, FL; Ponte Vedra, FL; Jacksonville Beach, FL; Jacksonville, FL; Fleming Island, FL |
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
2736 University Blvd W
Ste 3
Jacksonville, FL 32217
Phone (904) 292-8510
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254268800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1254268800000",
"number": "1962736413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2736 UNIVERSITY BLVD W",
"address_2": "SUITE 3",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322172179",
"telephone_number": "904-733-4262",
"fax_number": "904-636-5786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2736 UNIVERSITY BLVD W",
"address_2": "SUITE 3",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322172179",
"telephone_number": "904-733-4262",
"fax_number": "904-636-5786"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LYERLY BAPTIST INC",
"organizational_subpart": "NO",
"enumeration_date": "2009-09-30",
"last_updated": "2009-09-30",
"status": "A",
"authorized_official_last_name": "WILBANKS",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
"authorized_official_telephone_number": "904-376-4275"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NU",
"license": null,
"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 Sep 30, 2009; 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.