Provider Demographics
NPI:1417135005
Name:BAYFRONT MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:BAYFRONT MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ROCHELL
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-498-6474
Mailing Address - Street 1:15026 MADEIRA WAY
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1912
Mailing Address - Country:US
Mailing Address - Phone:727-498-6474
Mailing Address - Fax:727-498-6475
Practice Address - Street 1:15026 MADEIRA WAY
Practice Address - Street 2:
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-1912
Practice Address - Country:US
Practice Address - Phone:727-498-6474
Practice Address - Fax:727-498-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies