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NPI Code Detail

MEDICARE: BAYSIDE URGENT CARE CENTER INC.

MEDICARE: BAYSIDE URGENT CARE CENTER INC.
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
1261QU0200XUrgent Care Clinic/CenterBTR-0029514FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619257755
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAYSIDE URGENT CARE CENTER INC.
Provider Business Mailing Address
First Line : 10030 NEW PARKE RD
Second Line :
City : TAMPA
State : FL
Zip : 33626-5414
Country : US
Telephone Number : 813-508-2225
Fax Number : 813-920-4999
Provider Business Practice Location Address
First Line : 1001 S FORT HARRISON AVE
Second Line : SUITE 101
City : CLEARWATER
State : FL
Zip : 33756-3905
Country : US
Telephone Number : 813-508-2225
Fax Number : 813-920-4999
Authorized Official
Title or Position : PRESIDENT/CEO
Name : DR. RICHARD PETERKIN WALLACE
Credential : MD
Telephone Number : 813-508-2225
Provider Enumeration Date : 08/21/2011
Last Update Date : 08/21/2011

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Directions to “BAYSIDE URGENT CARE CENTER INC. ” Practice Location

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