Provider Demographics
NPI:1013011162
Name:BAY AREA ENDOSCOPY CENTER LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:BAY AREA ENDOSCOPY CENTER LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYAPRAKASH
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAMATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-528-2261
Mailing Address - Street 1:5771 49 STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2107
Mailing Address - Country:US
Mailing Address - Phone:727-528-2261
Mailing Address - Fax:727-526-7071
Practice Address - Street 1:5771 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2107
Practice Address - Country:US
Practice Address - Phone:727-528-2261
Practice Address - Fax:727-526-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL850261Q00000X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079148200Medicaid
000F1196Medicare ID - Type Unspecified