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SOUTHERN BAPTIST HOSPITAL - Florida Company Profile

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Company Details

Entity Name: SOUTHERN BAPTIST HOSPITAL
Jurisdiction: FLORIDA
Filing Type: Foreign Non-Profit
Status: Inactive
Date Filed: 18 Jul 1953 (72 years ago)
Date of dissolution: 21 Oct 1974 (51 years ago)
Last Event: DISSOLVED BY PROCLAMATION
Event Date Filed: 21 Oct 1974 (51 years ago)
Document Number: 809419
FEI/EIN Number 000000000
Address: 800 PRUDENTIAL DR., JACKSONVILLE FLA, 32207
Mail Address: 800 PRUDENTIAL DR., JACKSONVILLE FLA, 32207
ZIP code: 32207
City: Jacksonville
County: Duval
Place of Formation: LOUISIANA

Key Officers & Management

Name Role Address
CAMP, GERALD Secretary 7224 LORAIN, JACKSONVILLE, FL
- Director -
LIPSCOMB, CLYDE B. President 4344 LANDOVER DR., JACKSONVILLE, FL
GOODING, MARION W. Vice President 4105 SAN JOSE BLVD., JACKSONVILLE, FL
PRICE, ZINN O Director 12570 MANDARIN RD., JACKSONVILLE, FL
HARDEN, M.C. Director P. O. BOX 3214, JACKSONVILLE, FL
FAY, LAWRENCE D. Agent JACKSONVILLE, FL, 32202

National Provider Identifier

NPI Number:
1861693632

Authorized Person:

Name:
DR. ELLEN WILLIAMS
Role:
DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
No
Selected Taxonomy:
103TC1900X - Counseling Psychologist
Is Primary:
No
Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
No

Contacts:

Fax:
9047339598

Events

Event Type Filed Date Value Description
DISSOLVED BY PROCLAMATION 1974-10-21 - -

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Date of last update: 03 Aug 2025

Sources: Florida Department of State