MEDICARE: ALL BAY MEDICAL INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	1312512	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R9646	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1811956113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL BAY MEDICAL INC

Provider Business Mailing Address
First Line	:	4433 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-8731
Country	:	US
Telephone Number	:	813-963-2438
Fax Number	:	813-963-2564

Provider Business Practice Location Address
First Line	:	4433 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-8731
Country	:	US
Telephone Number	:	813-963-2438
Fax Number	:	813-963-2564

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONALD L FORTUNE SR.
Credential	:
Telephone Number	:	813-963-2438

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/22/2020

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