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General NPI Number Information
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NPI Number | 1275774127
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Entity Type | Organization
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Legal Business Name | BAYCARE AMBULATORY SERVICES
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 8452 118TH AVE
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City | LARGO
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State | FL
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Zip | 33773-5007
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Country | US
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Telephone | 727-394-6725
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Fax | 727-394-6739
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Provider Business Mailing Address
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Address Line | 8452 118TH AVE
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City | LARGO
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State | FL
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Zip | 33773-5007
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Country | US
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Telephone | 727-394-6725
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Fax | 727-394-6739
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Authorized Official
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Title or Position | OUTREACH LAB DIRECTOR
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Name | MS. DONNA NELSON LYNCH
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Credential | MT (ASCP)
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Telephone | 727-394-6725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | LAB800000172
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | LAB800000310
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License Number State | FL
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