Provider Demographics
NPI:1003117466
Name:BAY QUALITY PROSTHETICS LLC
Entity Type:Organization
Organization Name:BAY QUALITY PROSTHETICS LLC
Other - Org Name:BAY PROSTHETIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-522-5343
Mailing Address - Street 1:2195 JENKS AVE STE C
Mailing Address - Street 2:STE D
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4683
Mailing Address - Country:US
Mailing Address - Phone:850-522-5343
Mailing Address - Fax:850-640-0901
Practice Address - Street 1:2195 JENKS AVE STE C
Practice Address - Street 2:STE D
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4683
Practice Address - Country:US
Practice Address - Phone:850-522-5343
Practice Address - Fax:850-640-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR31332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment