Provider Demographics
NPI:1518024462
Name:BAPTIST MEDICAL CENTER OF NASSAU INC
Entity type:Organization
Organization Name:BAPTIST MEDICAL CENTER OF NASSAU INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-376-3760
Mailing Address - Street 1:PO BOX 44114
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4114
Mailing Address - Country:US
Mailing Address - Phone:904-376-4182
Mailing Address - Fax:904-376-4280
Practice Address - Street 1:1250 S 18TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1902
Practice Address - Country:US
Practice Address - Phone:904-376-4182
Practice Address - Fax:904-376-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4355282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00163336AOtherMEDICAID OF GA PROVIDER N
FL010123100Medicaid
FL115OtherBLUE CROSS OF FL PROVIDER
GA00163336AOtherMEDICAID OF GA PROVIDER N