MEDICARE: BAYDOCK EMERGENCY PHYSICIANS

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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21354	OTHER	FL	BLUE SHIELD

General Provider Information

NPI Number	:	1447209002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYDOCK EMERGENCY PHYSICIANS

Provider Business Mailing Address
First Line	:	PO BOX 13953
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19101-3953
Country	:	US
Telephone Number	:	800-507-8874
Fax Number	:	727-507-3630

Provider Business Practice Location Address
First Line	:	6600 MADISON ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-1971
Country	:	US
Telephone Number	:	727-841-4611
Fax Number	:	727-843-4501

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	TERRY MEADOWS
Credential	:
Telephone Number	:	800-507-8874

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	04/20/2008

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