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NPI Code Detail

MEDICARE: BAY AREA EMERGENCY PHYSICIANS URGENT CARE LLC

MEDICARE: BAY AREA EMERGENCY PHYSICIANS URGENT CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1124421409
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAY AREA EMERGENCY PHYSICIANS URGENT CARE LLC
Provider Business Mailing Address
First Line : PO BOX 1728
Second Line :
City : CLEARWATER
State : FL
Zip : 33757-1728
Country : US
Telephone Number : 727-532-1355
Fax Number :
Provider Business Practice Location Address
First Line : 6909 W WATERS AVE
Second Line :
City : TAMPA
State : FL
Zip : 33634-2213
Country : US
Telephone Number : 727-532-1355
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : DAN POLEN
Credential :
Telephone Number : 727-461-8234
Provider Enumeration Date : 10/01/2014
Last Update Date : 10/01/2014

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Directions to “BAY AREA EMERGENCY PHYSICIANS URGENT CARE LLC ” Practice Location

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