1275774127 NPI number — BAYCARE AMBULATORY SERVICES

Table of content: (NPI 1275774127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275774127 NPI number — BAYCARE AMBULATORY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYCARE AMBULATORY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BAYCARE OUTREACH LABORATORY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275774127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8452 118TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33773-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-394-6725
Provider Business Mailing Address Fax Number:
727-394-6739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8452 118TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33773-5007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-394-6725
Provider Business Practice Location Address Fax Number:
727-394-6739
Provider Enumeration Date:
03/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LYNCH
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
NELSON
Authorized Official Title or Position:
OUTREACH LAB DIRECTOR
Authorized Official Telephone Number:
727-394-6725

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  LAB800000310 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: LAB800000172 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com