Provider Demographics
NPI:1033135231
Name:HEALTH SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:HEALTH SUPPORT SERVICES INC
Other - Org Name:PEDIATRICS BY THE BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:D A
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-625-8260
Mailing Address - Street 1:7101 HIGHWAY 90
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526
Mailing Address - Country:US
Mailing Address - Phone:251-625-8260
Mailing Address - Fax:251-625-8264
Practice Address - Street 1:7101 HIGHWAY 90
Practice Address - Street 2:SUITE 204
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526
Practice Address - Country:US
Practice Address - Phone:251-625-8260
Practice Address - Fax:251-625-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty