Healthcare Provider Details

I. General information

NPI: 1720078041
Provider Name (Legal Business Name): BAY COUNTY HEALTH SYSTEM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-1511
  • Fax: 850-747-6842
Mailing address:
  • Phone: 850-747-6045
  • Fax: 850-763-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2896
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number3982
License Number StateFL

VIII. Authorized Official

Name: STEPHAN FRANK QUIRICONI
Title or Position: CFO
Credential:
Phone: 904-308-1258