1306057187 NPI number — BAYCARE BEHAVIORAL HEALTH CENTERS, INC

Table of content: (NPI 1306057187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306057187 NPI number — BAYCARE BEHAVIORAL HEALTH CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYCARE BEHAVIORAL HEALTH CENTERS, 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:
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:
1306057187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23788
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33623-3788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-750-8103
Provider Business Mailing Address Fax Number:
866-788-0863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 4TH ST N
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-750-8103
Provider Business Practice Location Address Fax Number:
866-788-0863
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COATES
Authorized Official First Name:
BOBBY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-403-5221

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: KO333 . This is a "GROUP BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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