MEDICARE: BAY AREA HEALTH CLINIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CE4221	OTHER	MI	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1013923770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA HEALTH CLINIC PC

Provider Business Mailing Address
First Line	:	2133 HERITAGE DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9461
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3720 KATALIN CT
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2160
Country	:	US
Telephone Number	:	989-686-2800
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. CHANDRA SHRESTHA
Credential	:
Telephone Number	:	989-686-2800

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/16/2007

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