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General NPI Number Information
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NPI Number | 1962641498
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Entity Type | Organization
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Legal Business Name | BAYA BARIATRICS URGENT CARE
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Dates
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Enumeration Date | 02/06/2009
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 373 SE COUNTRY CLUB RD
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City | LAKE CITY
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State | FL
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Zip | 32025-4987
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Country | US
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Telephone | 386-755-8909
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Fax |
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Provider Business Mailing Address
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Address Line | 373 SE COUNTRY CLUB RD
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City | LAKE CITY
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State | FL
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Zip | 32025-4987
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Country | US
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Telephone | 386-755-8909
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. DENISE CONE
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Credential |
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Telephone | 904-406-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | PA2310
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License Number State | FL
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