Provider Demographics
NPI:1023036688
Name:BAYSIDE AMBULATORY CENTER, LLC
Entity Type:Organization
Organization Name:BAYSIDE AMBULATORY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:3641 S MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4205
Mailing Address - Country:US
Mailing Address - Phone:305-854-3636
Mailing Address - Fax:305-854-3646
Practice Address - Street 1:3641 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4205
Practice Address - Country:US
Practice Address - Phone:305-854-3636
Practice Address - Fax:305-854-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical