| Entity Name: | BAPTIST PEDIATRICS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Dec 1993 (31 years ago) |
| Document Number: | P93000086735 |
| FEI/EIN Number | 593215071 |
| Mail Address: | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207, US |
| Address: | 3563 PHILIPS HIGHWAY, BUILDING A, SUITE 101, JACKSONVILLE, FL, 32207, US |
| ZIP code: | 32207 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467608851 | 2008-08-18 | 2008-08-18 | 3945 SAN JOSE PARK DR, JACKSONVILLE, FL, 322174612, US | 3945 SAN JOSE PARK DR, JACKSONVILLE, FL, 322174612, US | |||||||||||||||
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| Phone | +1 904-731-3530 |
| Fax | 9047371548 |
Authorized person
| Name | EARL MALLY |
| Role | SR. VICE PRESIDENT |
| Phone | 9043764275 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Baity G. S | Agent | 841 PRUDENTIAL DR, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Groover Timothy MD | Vice President | 841 PRUDENTIAL DRIVE, SUITE 1601, JACKSONVILLE, FL, 32207 |
| BAITY G. S | Vice President | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207 |
| FINNEGAN T S | Vice President | 841 Prudential Dr., Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Donaldson Marsha | Director | 3563 Philips Highway, Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Tickell Keith MD | Treasurer | 841 Prudential Drive, Jacksonville, FL, 32207 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2001-01-10 | BAPTIST PEDIATRICS, INC. | No data |
| NAME CHANGE AMENDMENT | 1996-07-31 | BAPTIST/ST. VINCENT'S PEDIATRICS, INC. | No data |
| NAME CHANGE AMENDMENT | 1995-07-24 | INTERNAL MEDICINE GROUP OF JACKSONVILLE, INC. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
