1659490894 NPI number — BAY CITY ASSOCIATES IN PODIATRY INC

Table of content: (NPI 1659490894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659490894 NPI number — BAY CITY ASSOCIATES IN PODIATRY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY CITY ASSOCIATES IN PODIATRY 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:
1659490894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3850 WALKER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16509-1627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-864-2360
Provider Business Mailing Address Fax Number:
814-864-2383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3850 WALKER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16509-1627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-864-2360
Provider Business Practice Location Address Fax Number:
814-864-2383
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OLSON
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
814-864-2360

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  213E50103X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 443626 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 208378 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1500186 . This is a "GATEWAY ASSURED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4099240 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 10937716 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 315569 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 748412 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 64728 . This is a "UNISON ADV" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 443626 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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