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General NPI Number Information
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NPI Number | 1003117466
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Entity Type | Organization
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Legal Business Name | BAY QUALITY PROSTHETICS LLC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 2195 JENKS AVE STE C STE D
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City | PANAMA CITY
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State | FL
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Zip | 32405-4683
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Country | US
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Telephone | 850-522-5343
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Fax | 850-640-0901
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Provider Business Mailing Address
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Address Line | 2195 JENKS AVE STE C STE D
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City | PANAMA CITY
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State | FL
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Zip | 32405-4683
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Country | US
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Telephone | 850-522-5343
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Fax | 850-640-0901
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Authorized Official
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Title or Position | SOLE MBR
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Name | MR. GLENN COTTRILL
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Credential |
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Telephone | 850-522-5343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | POR31
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License Number State | FL
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