Provider Demographics
NPI:1326381542
Name:BAYSIDE MEDICAL SERVICES
Entity Type:Organization
Organization Name:BAYSIDE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-504-8794
Mailing Address - Street 1:3208 MADDEN TER
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-4213
Mailing Address - Country:US
Mailing Address - Phone:757-504-8794
Mailing Address - Fax:757-483-8362
Practice Address - Street 1:3208 MADDEN TER
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-4213
Practice Address - Country:US
Practice Address - Phone:757-504-8794
Practice Address - Fax:757-483-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA341600000X, 343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance
No343800000XTransportation ServicesSecured Medical Transport (VAN)