MEDICARE: BAYSIDE MOBILE MEDICAL SERVICE

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	251E00000X	Home Health Agency	CPT16284	CA

General Provider Information

NPI Number	:	1962682062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSIDE MOBILE MEDICAL SERVICE

Provider Business Mailing Address
First Line	:	390 BARTLETT ST APT 9
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-3856
Country	:	US
Telephone Number	:	415-608-2174
Fax Number	:	925-849-4402

Provider Business Practice Location Address
First Line	:	390 BARTLETT ST APT 9
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-3856
Country	:	US
Telephone Number	:	415-608-2174
Fax Number	:	925-849-4402

Authorized Official
Title or Position	:	PRESIDENT CEO PHLEBOTOMIST
Name	:	NATHAN DAVID CRON
Credential	:	CPT, CNA, EMT
Telephone Number	:	415-608-2174

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	11/07/2007

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