Healthcare Provider Details

I. General information

NPI: 1942207121
Provider Name (Legal Business Name): BAY CITY ORTHOCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 PEACH ST
ERIE PA
16502-2822
US

IV. Provider business mailing address

2313 PEACH ST
ERIE PA
16502-2822
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-4632
  • Fax: 814-452-4636
Mailing address:
  • Phone: 814-452-4632
  • Fax: 814-452-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6000006121
License Number StatePA

VIII. Authorized Official

Name: DIANE L DESARRO
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 814-452-4632