Provider Demographics
NPI:1447426002
Name:BAYWAY MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:BAYWAY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:PLANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-867-7910
Mailing Address - Street 1:5901 SUN BLVD
Mailing Address - Street 2:#113
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1166
Mailing Address - Country:US
Mailing Address - Phone:727-867-7910
Mailing Address - Fax:727-867-6379
Practice Address - Street 1:5901 SUN BLVD
Practice Address - Street 2:#113
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-1166
Practice Address - Country:US
Practice Address - Phone:727-867-7910
Practice Address - Fax:727-867-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67437261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE34727Medicare UPIN
FLQ57869Medicare UPIN