| Entity Name: | BAPTIST MEDICAL CENTER OF THE BEACHES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 27 Nov 1989 (35 years ago) |
| Document Number: | N35375 |
| FEI/EIN Number | 592980620 |
| Mail Address: | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207, US |
| Address: | 841 PRUDENTIAL DRIVE, JACKSONVILLE BEACH, FL, 32250, US |
| ZIP code: | 32250 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821155912 | 2007-01-02 | 2022-06-02 | P O BOX 45058, JACKSONVILLE, FL, 322325058, US | 1350 13TH AVE S, JACKSONVILLE BEACH, FL, 322503203, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 904-376-4182 |
| Fax | 9043764280 |
Authorized person
| Name | PHILIP BOYCE |
| Role | CHIEF REVENUE OFFICER |
| Phone | 9043763760 |
Taxonomy
| Taxonomy Code | 282N00000X - General Acute Care Hospital |
| License Number | 4304 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS PROVIDER NUMBE |
| Number | 128 |
| State | FL |
| Issuer | MEDICAID |
| Number | 010232600 |
| State | FL |
| Issuer | MEDICAID OF GA PROVIDER |
| Number | 00150345A |
| State | GA |
| Name | Role | Address |
|---|---|---|
| Baity G. SEsq. | Agent | 841 PRUDENTIAL DR, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Mayo Michael A | President | 841 PRUDENTIAL DRIVE, SUITE 1601, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Baity G. S | Assistant Secretary | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Hoffman Christine | Director | 1350 13TH AVENUE SOUTH, JACKSONVILLE BEACH, FL, 32250 |
| Mayo Michael A | Director | 841 PRUDENTIAL DRIVE, SUITE 1601, JACKSONVILLE, FL, 32207 |
| Coughlin Joyce Keli | Director | 1350 13th Avenue South, Jacksonville Beach, FL, 32250 |
| Name | Role | Address |
|---|---|---|
| Hoffman Christine | Vice Chairman | 1350 13TH AVENUE SOUTH, JACKSONVILLE BEACH, FL, 32250 |
| Name | Role | Address |
|---|---|---|
| Finnegan SCOTT | Asst | 841 Prudential Drive, Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Dreicer Jarret A | Vice President | 1350 13th Avenue South, Jacksonville Beach, FL, 32250 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000100243 | BAPTIST SLEEP TESTING | ACTIVE | 2024-08-22 | 2029-12-31 | No data | 6930 BONNEVAL RD. #2, JACKSONVILLE, FL, 32216 |
| G22000114823 | BAPTIST BEACHES | ACTIVE | 2022-09-13 | 2027-12-31 | No data | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207 |
| G22000114827 | BAPTIST HEALTH REHABILITATION SERVICES | ACTIVE | 2022-09-13 | 2027-12-31 | No data | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207 |
| G22000090169 | BAPTIST MEDICAL CENTER BEACHES | ACTIVE | 2022-08-01 | 2027-12-31 | No data | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207 |
| G16000052236 | BAPTIST MEDICAL CENTER BEACHES | EXPIRED | 2016-05-25 | 2021-12-31 | No data | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES | 2000-05-10 | No data | No data |
| AMENDMENT | 1999-11-01 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 1995-06-01 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 1991-06-28 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 1990-02-08 | No data | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
