Healthcare Provider Details

I. General information

NPI: 1659016509
Provider Name (Legal Business Name): BAYWEST MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 STATE ROAD 54
NEW PORT RICHEY FL
34652-6020
US

IV. Provider business mailing address

5633 STATE ROAD 54
NEW PORT RICHEY FL
34652-6020
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-0091
  • Fax: 727-372-0192
Mailing address:
  • Phone: 727-372-0091
  • Fax: 727-372-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENIFER MCCOWAN
Title or Position: ADMINISTRATION
Credential:
Phone: 727-372-0091