Healthcare Provider Details

I. General information

NPI: 1467896977
Provider Name (Legal Business Name): BAY MEDICAL CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 E PRIMROSE ST STE A
SPRINGFIELD MO
65804-4586
US

IV. Provider business mailing address

2139 E PRIMROSE ST STE A
SPRINGFIELD MO
65804-4586
US

V. Phone/Fax

Practice location:
  • Phone: 417-414-3050
  • Fax: 417-881-8862
Mailing address:
  • Phone: 417-414-3050
  • Fax: 417-881-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANUPREET SIDHU
Title or Position: ACCESS MANAGER
Credential:
Phone: 417-414-3050