Healthcare Provider Details

I. General information

NPI: 1588879266
Provider Name (Legal Business Name): BAYSIDE ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SOUTH COUNTY TRAIL BUILDING #4, SUITE 411
EAST GREENWICH RI
02818
US

IV. Provider business mailing address

1407 SOUTH COUNTY TRAIL BUILDING #4, SUITE 411
EAST GREENWICH RI
02818
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-1810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BOYD BALDOCK
Title or Position: OFFICE AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954