1720078041 NPI number — BAY COUNTY HEALTH SYSTEM, LLC

Table of content: (NPI 1720078041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720078041 NPI number — BAY COUNTY HEALTH SYSTEM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY COUNTY HEALTH SYSTEM, LLC
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:
1720078041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 N BONITA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32401-3623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-747-6045
Provider Business Mailing Address Fax Number:
850-763-8827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 N BONITA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32401-3623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-747-1511
Provider Business Practice Location Address Fax Number:
850-747-6842
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
QUIRICONI
Authorized Official First Name:
STEPHAN
Authorized Official Middle Name:
FRANK
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
904-308-1258

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  3982 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 341600000X , with the licence number: 2896 , 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)

  • Identifier: 010006400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 056445100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 033526600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 088052300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 419 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 596001478 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 162945400 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010006400 . 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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