Provider Demographics
NPI:1093381063
Name:BAY STREET CLINIC LLC
Entity Type:Organization
Organization Name:BAY STREET CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-546-1011
Mailing Address - Street 1:403 BAY ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5107
Mailing Address - Country:US
Mailing Address - Phone:256-546-1011
Mailing Address - Fax:256-467-3294
Practice Address - Street 1:403 BAY ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5107
Practice Address - Country:US
Practice Address - Phone:256-546-1011
Practice Address - Fax:256-467-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty