Provider Demographics
NPI:1073935540
Name:BAY ARTHRITIS INSTITUTE
Entity Type:Organization
Organization Name:BAY ARTHRITIS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION/ HEAD BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLENNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-215-3062
Mailing Address - Street 1:P.O. BOX 15459
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5459
Mailing Address - Country:US
Mailing Address - Phone:850-215-3062
Mailing Address - Fax:850-215-3024
Practice Address - Street 1:2401 STATE AVE STE 100
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3942
Practice Address - Country:US
Practice Address - Phone:850-215-3062
Practice Address - Fax:850-215-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106424207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020424800Medicaid
FLHS149AOtherMEDICARE PIN
FLDH249AMedicare PIN