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General NPI Number Information
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NPI Number | 1770991499
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Entity Type | Organization
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Legal Business Name | BAY CITY PSYCHIATRY, LLC
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 3250 W. LAKE RD SUITE 1
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City | ERIE
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State | PA
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Zip | 16505-3691
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Country | US
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Telephone | 814-454-1085
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Fax | 814-240-3976
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Provider Business Mailing Address
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Address Line | 3250 W. LAKE RD SUITE 1
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City | ERIE
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State | PA
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Zip | 16505-3691
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Country | US
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Telephone | 814-454-1085
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Fax | 814-240-3976
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MATHEW W SIPPLE
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Credential | D.O.
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Telephone | 814-454-1085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | OS13457
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License Number State | PA
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