1518604693 NPI number — BAYCARE PASCO, INC.

Table of content: (NPI 1518604693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518604693 NPI number — BAYCARE PASCO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYCARE PASCO, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1518604693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2985 DREW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33759-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-281-9077
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 BRUCE B DOWNS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESLEY CHAPEL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33544-9216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-914-1000
Provider Business Practice Location Address Fax Number:
813-914-1913
Provider Enumeration Date:
05/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
GUY
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-519-1222

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 118764400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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