MEDICARE: BAYCARE AMBULATORY SERVICES

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
1	291U00000X	Clinical Medical Laboratory	LAB800000172	FL
2	291U00000X	Clinical Medical Laboratory	LAB800000310	FL

General Provider Information

NPI Number	:	1275774127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYCARE AMBULATORY SERVICES

Provider Business Mailing Address
First Line	:	8452 118TH AVE
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-5007
Country	:	US
Telephone Number	:	727-394-6725
Fax Number	:	727-394-6739

Provider Business Practice Location Address
First Line	:	8452 118TH AVE
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-5007
Country	:	US
Telephone Number	:	727-394-6725
Fax Number	:	727-394-6739

Authorized Official
Title or Position	:	OUTREACH LAB DIRECTOR
Name	:	MS. DONNA NELSON LYNCH
Credential	:	MT (ASCP)
Telephone Number	:	727-394-6725

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/23/2009

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Directions to “BAYCARE AMBULATORY SERVICES ” Practice Location

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