Healthcare Provider Details

I. General information

NPI: 1689850042
Provider Name (Legal Business Name): BAY HARBOR MED CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 JESSIE DUPONT MEM HWY
BURGESS VA
22432-0400
US

IV. Provider business mailing address

PO BOX 400
BURGESS VA
22432-0400
US

V. Phone/Fax

Practice location:
  • Phone: 804-453-7122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateVA

VIII. Authorized Official

Name: VERA BEATLEY
Title or Position: CO OWNER
Credential:
Phone: 804-453-7122