Healthcare Provider Details

I. General information

NPI: 1962783472
Provider Name (Legal Business Name): BAYSIDE ORTHOPAEDIC & REHABILITATION CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 HAND AVE
BAY MINETTE AL
36507-4110
US

IV. Provider business mailing address

PO BOX 1186
FAIRHOPE AL
36533-1186
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-2401
  • Fax: 251-928-5099
Mailing address:
  • Phone: 251-928-2401
  • Fax: 251-928-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: RACHEL L ELLIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 251-928-2401