Provider Demographics
NPI:1003070608
Name:BAY PINES VA MEDICAL CENTER
Entity Type:Organization
Organization Name:BAY PINES VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING CHIEF PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:LARCKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-398-6661
Mailing Address - Street 1:712 DERBYSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1606
Mailing Address - Country:US
Mailing Address - Phone:386-274-3460
Mailing Address - Fax:386-274-3487
Practice Address - Street 1:1920 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5103
Practice Address - Country:US
Practice Address - Phone:386-274-3460
Practice Address - Fax:386-274-3487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility