Provider Demographics
NPI:1326101205
Name:BAY PEDIATRIC CLINIC
Entity Type:Organization
Organization Name:BAY PEDIATRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MONVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-892-2517
Mailing Address - Street 1:2110 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7609
Mailing Address - Country:US
Mailing Address - Phone:989-892-2517
Mailing Address - Fax:989-892-4860
Practice Address - Street 1:2110 16TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7609
Practice Address - Country:US
Practice Address - Phone:989-892-2517
Practice Address - Fax:989-892-4860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350Z96028OtherBLUE CROSS