Provider Demographics
NPI:1407162654
Name:MEL-BAY HEALTH CARE INC
Entity Type:Organization
Organization Name:MEL-BAY HEALTH CARE INC
Other - Org Name:LISA A BAKER MSN ARNP FNP-BC LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATSAMATLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-473-8400
Mailing Address - Street 1:P.O BOX 560010
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956
Mailing Address - Country:US
Mailing Address - Phone:321-473-8400
Mailing Address - Fax:321-914-0888
Practice Address - Street 1:950 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-473-8400
Practice Address - Fax:321-914-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2024-01-11
Deactivation Date:2023-11-02
Deactivation Code:
Reactivation Date:2023-12-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH75508Medicare UPIN
FLDR540AMedicare PIN