Provider Demographics
NPI:1003080722
Name:BAY CENTRAL MEDICAL GROUP
Entity Type:Organization
Organization Name:BAY CENTRAL MEDICAL GROUP
Other - Org Name:INFANTE MEDICAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-873-1725
Mailing Address - Street 1:4712 N ARMENIA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2611
Mailing Address - Country:US
Mailing Address - Phone:813-873-1725
Mailing Address - Fax:813-873-2924
Practice Address - Street 1:4712 N ARMENIA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2611
Practice Address - Country:US
Practice Address - Phone:813-873-1725
Practice Address - Fax:813-873-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95998207Q00000X
FLME 80860208000000X
FLME 59316208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty