Healthcare Provider Details

I. General information

NPI: 1619248473
Provider Name (Legal Business Name): BAY AREA MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 SHORE DR
MARINETTE WI
54143-4293
US

IV. Provider business mailing address

3100 SHORE DR
MARINETTE WI
54143-4242
US

V. Phone/Fax

Practice location:
  • Phone: 715-732-8200
  • Fax: 715-732-8205
Mailing address:
  • Phone: 715-735-1721
  • Fax: 715-735-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number155
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number155
License Number StateWI

VIII. Authorized Official

Name: DAWN M LAPLANT
Title or Position: CLINIC BUSINESS SERVICES MANAGER
Credential:
Phone: 715-735-1722