Provider Demographics
NPI:1275774127
Name:BAYCARE AMBULATORY SERVICES
Entity Type:Organization
Organization Name:BAYCARE AMBULATORY SERVICES
Other - Org Name:BAYCARE OUTREACH LABORATORY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OUTREACH LAB DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:MT (ASCP)
Authorized Official - Phone:727-394-6725
Mailing Address - Street 1:8452 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5007
Mailing Address - Country:US
Mailing Address - Phone:727-394-6725
Mailing Address - Fax:727-394-6739
Practice Address - Street 1:8452 118TH AVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5007
Practice Address - Country:US
Practice Address - Phone:727-394-6725
Practice Address - Fax:727-394-6739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLAB800000310291U00000X
FLLAB800000172291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory